Prevalence and Location of Neuropathic Pain in Lumbar Spinal Disorders

Analysis of 1804 Consecutive Patients With Primary Lower Back Pain

Sumihisa Orita, MD, PhD; Toshihiko Yamashita, MD, PhD; Seiji Ohtori, MD, PhD; Kazuo Yonenobu, MD, PhD; Mamoru Kawakami, MD, PhD; Toshihiko Taguchi, MD, PhD; Shin-ichi Kikuchi, MD, PhD; Takahiro Ushida, MD, PhD; Shin-ichi Konno, MD, PhD; Masaya Nakamura, MD, PhD; Keiji Fujino, MD, PhD; Shuichi Matsuda, MD, PhD; Kazunori Yone, MD, PhD; Kazuhisa Takahashi, MD, PhD

Disclosures

Spine. 2016;41(15):1224-1231. 

In This Article

Abstract and Introduction

Abstract

Study Design. A cross-sectional study of 1804 consecutive patients.

Objective. The aim of this study was to investigate the prevalence of pathological pain and its distribution features in patients with chronic lumbar spinal disorders.

Summary of Background Data. Clinical spinal disorders can involve pathological neuropathic pain (NeP) as well as physiological nociceptive pain (NocP), as they have varied pathology, including spinal cord injury, stenosis, and compression. A study conducted by the Japanese Society for Spine Surgery and Related Research (JSSR) has determined a prevalence of 29.4% for NeP in patients with lumbar spinal disorder. However, the data did not include information on pain location.

Methods. Patients aged 20 to 79 years with chronic lower back pain (≥3 months, visual analog scale score ≥30) were recruited from 137 JSSR-related institutions. Patient data included an NeP screening questionnaire score and pain location (lower back, buttock, and legs). The association between the pain pathology and its location was analyzed statistically using the unpaired t test and Chi-square test followed by Fisher test. P < 0.05 was considered significant.

Results. Low back pain subjects showed 31.9% of NeP prevalence, and the pain distribution showed [NocP(%)/NeP(%)] low back pain only cases: 44/22, while low back pain with leg pain cases showed a prevalence of 56/78. This indicates that low back pain alone can significantly induce NocP rather than NeP (P < 0.01). Buttock pain was revealed to significantly induce both lower back pain and leg pain with NeP properties (P < 0.01). Leg pain was revealed to be predominantly neuropathic, especially when it included peripheral pain (P < 0.01).

Conclusion. Low back pain with no buttock pain induces NocP rather than NeP. Buttock pain is significantly associated with NeP prevalence whether or not leg pain exists. Leg pain can increase the prevalence of NeP, especially when it contains a peripheral element.

Level of Evidence: 3

Introduction

Lower back pain (LBP) is a worldwide issue with prevalence averaging 30% in the US;[1] onset most often occurs between the ages of 30 and 50 years. LBP is also associated with extensive medical expenses and work-related disability, and it should thus be effectively and rapidly treated. Clinical spinal pathologies including LBP involve several kinds of pain. Neuropathic pain (NeP) is pathological pain derived from neural damage or from physiological nociceptive pain (NocP), and it has been reported in specific pathologies such as painful diabetic neuropathy (9–26%), postspinal cord injury neuropathy (10–80%), and postcerebrovascular NeP (8–11%).[2] Spinal disorders can induce NeP in cases of pathology such as canal stenosis caused by hypertrophic ligamentum flavum, spondylolisthesis, and disc bulging followed by nerve compression. The Japanese Society for Spine Surgery and Related Research (JSSR) has reported an overall NeP prevalence of 53.3% in spinal disease, and 29.4% of these patients suffer from LBP.[3] However, these data do not include details regarding the location of the pain such as the lower back, buttock, or legs. Although such location-related information is not typically taken into account in current treatment design and clinical decision-making for LBP, we believe that understanding the characteristic details of the pain such as the association between the particular pain symptoms and their locations will enable clinicians to suggest more efficient treatment strategies. Furthermore, these analyses can provide additional information for resolving the pathologies of nonspecific LBP, that is, LBP without an exact pathoanatomical diagnosis, which accounts for as much as 85% of LBP patients.[4] In particular, pain location has not been well addressed in previous studies, which has resulted in a rather obscure understanding of pain characterizing, that is, that radiating leg pain can be NeP.

The current study aimed to reanalyze the data provided by the JSSR to determine the prevalence of NeP prevalence in lumbar spinal disorders, with a specific focus on characterizing the pain according to its location.

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