Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (±leg) pain

Object The objective of this study was to evaluate the efficacy of chronic subthalamic nucleus (STN) stimulation for alleviating pain related to Parkinson disease (PD). Methods Among 163 consecutive patients undergoing STN stimulation, 69 were identified as experiencing pain preoperatively that was related to their PD. All 69 patients suffering from pain were followed up prospectively for 12 months after surgery. All patients described the severity of their pain according to a visual analog scale (VAS) preoperatively and at 2 weeks, 6 months, and 12 months postoperatively. Pain unrelated to PD was not studied. Results Several types of pain related to PD, the categories of which were based on a modification of 2 previous classifications (Ford and Honey), can occur in such patients: 1) musculoskeletal pain, 2) dystonic pain, 3) somatic pain exacerbated by PD, 4) radicular/peripheral neuropathic pain, and 5) central pain. The overall mean VAS score was significantly decreased postoperatively by 75% and 69% at 2 weeks and 6 months, respectively (p < 0.001). The mean VAS score at 12 months was also decreased by 80%, but 6 instances of pain (3 reports of somatic back pain and 3 reports of radicular/peripheral neuropathic pain) required additional spinal surgery to alleviate the pain severity. The results were analyzed using the Wilcoxon signed-rank test and demonstrated a significant reduction in VAS scores at all follow-up assessments (p < 0.001). Musculoskeletal pain and dystonic pain were well alleviated by STN stimulation. In contrast, somatic pain exacerbated by PD and peripheral neuropathic pain originating from lumbar spinal diseases, such as spondylosis deformans and/or canal stenosis, often deteriorated postoperatively despite attenuation of the patients' motor disability. Patients with central pain were poor responders. Conclusions This study found that STN stimulation produced significant improvement of overall pain related to PD in patients with advanced PD, and the efficacy continued for at least 1 year. The present results indicate that musculoskeletal pain and dystonic pain responded well to STN stimulation, but patients with back pain (somatic pain) and radicular/peripheral neuropathic pain originating from spinal disease have a potential risk for postoperative deterioration of their pain.

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Commentary on: Neuropathic pain in low back-related leg pain patients: What is the evidence of prevalence, characteristics, and prognosis in primary care? A systematic review of the literature

Surgical Neurology International ◽

10.4103/sni.sni_413_17 ◽

2018 ◽

Vol 9 (1) ◽

pp. 23

Author(s):

JeffreyA Brown

Keyword(s):

Systematic Review ◽

Primary Care ◽

Neuropathic Pain ◽

Leg Pain ◽

Low Back ◽

Review Of The Literature ◽

Pain Patients

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Clinical indicators to identify neuropathic pain in low back-related leg pain: protocol for a modified Delphi study

BMJ Open ◽

10.1136/bmjopen-2019-033547 ◽

2020 ◽

Vol 10 (2) ◽

pp. e033547 ◽

Cited By ~ 1

Author(s):

Jai Mistry ◽

Deborah Falla ◽

Tim Noblet ◽

Nicola R Heneghan ◽

Alison B Rushton

Keyword(s):

Neuropathic Pain ◽

Delphi Study ◽

A Priori ◽

Healthcare Providers ◽

Leg Pain ◽

Eligibility Criterion ◽

Low Back ◽

Clinical Indicators ◽

Modified Delphi ◽

Ethical Approval

IntroductionNeuropathic low back-related leg pain (LBLP) can be a challenge to healthcare providers to diagnose and treat. Accurate diagnosis of neuropathic pain is fundamental to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose neuropathic LBLP. A Delphi study will therefore be conducted to obtain an expert-derived consensus list of clinical indicators to identify a neuropathic component to LBLP.Methods/analysisIncluded participants will be considered experts within the field as measured against a predefined eligibility criterion. Through an iterative multistage process, participants will rate their agreement with a list of clinical indicators and suggest any missing clinical indicators during each round. Agreement will be measured using a 5-point Likert scale. Descriptive statistics will be used to measure agreement; median, IQR and percentage of agreement. A priori consensus criteria will be defined for each round. Data analysis at the end of round three will enable a list of clinical indicators to be derived.Ethics and disseminationEthical approval was gained from the University of Birmingham (ERN_19-1142). On completion of the study, findings will be disseminated in a peer-reviewed journal and presented at relevant conferences.

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Depression, Anxiety and Quality of Life among Chronic Low Back-leg Pain Patients with or without Neuropathic Pain

British Journal of Pharmaceutical Research ◽

10.9734/bjpr/2016/28762 ◽

2016 ◽

Vol 13 (5) ◽

pp. 1-8

Author(s):

Özlem Uzun ◽

Filiz Acar ◽

Bedriye Başkan ◽

Hatice Bodur

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Leg Pain ◽

Low Back ◽

Pain Patients

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Clinical indicators to identify neuropathic pain in low back related leg pain: a modified Delphi study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03600-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jai Mistry ◽

Deborah Falla ◽

Tim Noblet ◽

Nicola R. Heneghan ◽

Alison Rushton

Keyword(s):

Neuropathic Pain ◽

Delphi Study ◽

Leg Pain ◽

Complete Agreement ◽

Low Back ◽

Eligibility Criteria ◽

Clinical Indicators ◽

Modified Delphi ◽

Coefficient Of Concordance ◽

Kendall’S W

Abstract Background Neuropathic pain (NP) is common in patients presenting with low back related leg pain. Accurate diagnosis of NP is fundamental to ensure appropriate intervention. In the absence of a clear gold standard, expert opinion provides a useful methodology to progress research and clinical practice. The aim of this study was to achieve expert consensus on a list of clinical indicators to identify NP in low back related leg pain. Methods A modified Delphi method consisting of three rounds was designed in accordance with the Conducting and Reporting Delphi Studies recommendations. Recruitment involved contacting experts directly and through expressions of interest on social media. Experts were identified using pre-defined eligibility criteria. Priori consensus criteria were defined for each round through descriptive statistics. Following completion of round 3 a list of clinical indicators that achieved consensus were generated. Results Thirty-eight participants were recruited across 11 countries. Thirty-five participants completed round 1 (92.1%), 32 (84.2%) round 2 and 30 (78.9%) round 3. Round 1 identified consensus (Kendall’s W coefficient of concordance 0.456; p < 0.001) for 10 clinical indicators out of the original 14, and 9 additional indicators were added to round 2 following content analysis of qualitative data. Round 2 identified consensus (Kendall’s W coefficient of concordance 0.749; p < 0.001) for 10 clinical indicators out of 19, and 1 additional indicator was added to round 3. Round 3 identified consensus for 8 indicators (Kendall’s W coefficient of concordance 0.648; p < 0.001). Following completion of the third round, an expert derived consensus list of 8 items was generated. Two indicators; pain variously described a burning, electric shock like and/or shooting into leg and pain in association with other neurological symptoms (e.g. pins and needles, numbness, weakness), were found to have complete agreement amongst expert participants. Conclusions Good agreement was found for the consensus derived list of 8 clinical indicators to identify NP in low back related leg pain. This list of indicators provide some indication of the criteria upon which clinicians can identify a NP component to low back related leg pain; further research is needed for stronger recommendations to be made.

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