Background/Purpose:

Low back pain (LBP) is one of the most challenging chronic pain conditions. The pathophysiology of LBP is complex and contains nociceptive and neuropathic pain (NP) pathways. NP may be associated with leg pain, sensory and motor deficits, disability and lower quality of life. The aim of this study was to evaluate the prevalance of NP in patients with LBP and the relationship of NP with demographic characteristics, body mass index (BMI) and pain duration.

Methods:

440 outpatient patients who applied to the PMR clinic of our research hospital with LBP from January 2017 to July 2017 were enrolled in the study. All the patients were evaluated with respect to NP. Data were collected using a structured questionnaire (demographics and LBP duration). Doulor Neuropathiqoe 4 (DN4) questionnaire was used to identify NP. The main type of pain was recorded (tingling, numbness, burning etc.). Any difference in demographic characteristics or duration of pain were investigated between the patients with and without NP. Binary logistics regression modeling was used to obtain a subset of sociodemographic factors that were independently associated with NP. Data were analyzed using NCSS 10 (2015. Kaysville, Utah, USA).

Results:

193 (43,9 %) of the 440 LBP patients had NP according to DN4 (score of DN4≥4) (95% confidence interval 39%-49%). Mean age of the patients was 44.8 years (± 13.7, min 18, max 85). 263 (59,8%) of the patients were female. The median duration of LBP was 24 months (with extremes of 3 days and 30 years). 343 (77,9%) of the patients had chronic LBP (more than 3 months). The average BMI was 27,98±4,54. 275 patients (62,9%) were not officially employed (housewife, retired, student etc.), 35 patients (7,7%) were office holder, 130 patients (29,6%) were high-activity worker. The most common types of pain were numbness (62% of the patients with NP), and burning (21%). Gender distrubition of the patients with and without NP was similar (p=0,237). The patients with NP were older (p<0,001), had higher BMI (p=0,005) and longer LBP duration (p<0,001) and had lower educational level (p:0,018). NP was significantly more common in unemployed patients and less common in high activity employees (p:0,001). Logistic regression analyses identified that high-active workers’ risk of having NP was 1,76 times lesser than other groups (office workers, housewives and retired patients) (p=0,039, OR(95%CI)=1,76(1,03-3,02)). Odds ratio of employment was not different in general (p=0,099). The predictive value of longer pain duration of having NP was close to significance (p=0,056)

Conclusion:

In our group, nearly half of the patients with LBP had accompanied NP. NP was remarkably more common in patients with low socioeconomic status and patients who perform high levels of physical activity at workplace had interestingly lower NP scores compared to patients with less physically activite lifestyles. Our results showing NP being more common in sedantery patients may suggest that emphasizing exercise training as a therapeutic intervention in LBP management could also be beneficial to NP also.

NP is associated with higher levels of pain and disability, clinicians should be mindful of NP management while LBP is being treated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-frequency-of-neuropathic-pain-in-patients-with-low-back-pain-and-the-relationship-with-demographic-characteristics-a-cross-sectional-study/