Evidence for the BUAS-test ability to diagnose lumbar radicular pain

2021 ◽  
pp. 204946372110057
Author(s):  
Boaz Gedaliahu Samolsky Dekel ◽  
Maria Cristina Sorella ◽  
Alessio Vasarri ◽  
Rita Maria Melotti
Keyword(s):  
Differential Diagnosis ◽  
Animal Studies ◽  
Multinomial Logistic Regression ◽  
Brief Pain Inventory ◽  
Radicular Pain ◽  
Diagnostic Ability ◽  
Pain Site ◽  
Straight Leg Raising ◽  
Lumbar Radicular Pain ◽  
Clinical Measures

Background: Differential diagnosis of low back pain (LBP) is complex and a prominent issue at all health-care levels; guidance may come from patients’ history cues and clinical examination signs. Human and animal studies report that diagnosis of lumbar radicular pain (LRP) may come from evaluating subjective responses of injured lumbar nerves to a strain applied at the buttock. The Buttock Applied Strain (BUAS-test) test may guide the differential diagnosis of LBP. Following an ex-adiuvantibus criterion, clinical improvement of LRP, diagnosed with the BUAS-test and congruently treated, may support this test diagnostic ability. Methods: Among 258 LRP patients, who, upon first visit (V1), tested positive on the BUAS-test (with/without positive Straight Leg Raising Test, SLRT), the effect of gabapentin prescription on painDETECT (PD) questionnaire and Brief Pain Inventory (BPI) outcomes was quantified in the follow-up visit (V2). To support BUAS-test diagnostic ability, we hypothesized that, at V2, >50% of the sample would present negative PD outcome, significant ( t-test) and ⩾2 points V2-V1 differences for each of the BPI-item’s score. We used multinomial logistic regression (MLR) and χ2 analyses to evaluate the PD-V2 outcomes’ dependence upon independent variables. Results: Of the sample, 77% reported a negative PD-V2 outcome. V2-V1 differences of all BPI items were significant and >2 points. PD-V2 outcomes showed significant associations with SLRT-V1 and PD-V1, respectively, but not with gender, age group or pain site. MLR showed a significant relationship between SLRT-V1 and PD-V2 outcomes. Conclusion: Among LRP patients, diagnosed by the BUAS-test and treated with gabapentin, all prespecified endpoints were reached. These results may be considered a piece of ex-adiuvantibus evidence for the BUAS-test ability to diagnose LRP. While positive BUAS-test implies potential LRP, the co-presence with positive SLRT may imply a severer LRP condition. Further prospective research, in different settings and direct clinical measures, is needed.

Topiramate in Chronic Lumbar Radicular Pain

2005 ◽  
Vol 6 (12) ◽  
pp. 829-836 ◽  
Author(s):  
Suzan Khoromi ◽  
Athos Patsalides ◽  
Suzan Parada ◽  
Vesta Salehi ◽  
Jennifer M. Meegan ◽  
...  
Keyword(s):  
Radicular Pain ◽  
Lumbar Radicular Pain

scholarly journals Role of IL1A rs1800587, IL1B rs1143627 and IL1RN rs2234677 Genotype Regarding Development of Chronic Lumbar Radicular Pain; a Prospective One-Year Study

PLoS ONE ◽  
2014 ◽  
Vol 9 (9) ◽  
pp. e107301 ◽  
Author(s):  
Aurora Moen ◽  
Elina Iordanova Schistad ◽  
Lars Jørgen Rygh ◽  
Cecilie Røe ◽  
Johannes Gjerstad
Keyword(s):  
Radicular Pain ◽  
Lumbar Radicular Pain ◽  
One Year

Disentangling ‘sciatica’ to understand and characterise somatosensory profiles and potential pain mechanisms

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Brigitte Tampin ◽  
Christopher Lind ◽  
Angela Jacques ◽  
Helen Slater
Keyword(s):  
Mechanical Vibration ◽  
Radicular Pain ◽  
Leg Pain ◽  
Heat Sensitivity ◽  
Loss Of Function ◽  
Pain Mechanisms ◽  
Vibration Detection ◽  
Lumbar Radicular Pain ◽  
Pain Experiences ◽  
Pain Descriptors

Abstract Objectives The study aimed to investigate if patients with lumbar radicular pain only and those with combined lumbar radicular pain + radiculopathy differ in their somatosensory profiles and pain experiences. Methods Quantitative sensory testing (QST) was performed in 26 patients (mean age 47 ± 10 years, 10 females) with unilateral leg pain in the L5 or S1 distribution in their main pain area (MPA) and contralateral mirror side, in the relevant foot dermatome on the symptomatic side and in the hand dorsum. Pain experience was captured on the painDETECT. Results Eight patients presented with lumbar radicular pain only and 18 patients with combined radicular pain + radiculopathy. Patients with radicular pain only demonstrated widespread loss of function (mechanical detection) bilaterally in the MPA (p<0.003) and hand (p=0.002), increased heat sensitivity in both legs (p<0.019) and cold/heat sensitivity in the hand (p<0.024). QST measurements in the dermatome did not differ compared to HCs and patients with radiculopathy. Patients with lumbar radiculopathy were characterised by a localised loss of function in the symptomatic leg in the MPA (warm, mechanical, vibration detection, mechanical pain threshold, mechanical pain sensitivity p<0.031) and dermatome (mechanical, vibration detection p<0.001), consistent with a nerve root lesion. Pain descriptors did not differ between the two groups with the exception of numbness (p<0.001). Patients with radicular pain did not report symptoms of numbness, while 78% of patients with radiculopathy did. Conclusions Distinct differences in somatosensory profiles and pain experiences were demonstrated for each patient group, suggesting differing underlying pain mechanisms.

scholarly journals Interlaminar Versus Transforaminal Epidural Steroids for the Treatment of Subacute Lumbar Radicular Pain: A Randomized, Blinded, Prospective Outcome Study

2011 ◽  
Vol 6;14 (6;12) ◽  
pp. 499-511 ◽  
Author(s):  
Christopher G. Gharibo
Keyword(s):  
Back Pain ◽  
Rating Scale ◽  
Steroid Injection ◽  
Relative Effectiveness ◽  
Radicular Pain ◽  
Physical Exam ◽  
Therapeutic Effects ◽  
Outcome Study ◽  
Lumbar Radicular Pain ◽  
Epidural Steroids

Background: There is uncertainty in the literature over the relative effectiveness of lumbar epidural interlaminar (IL) steroid injection versus transforaminal (TF) steroid injection for lumbar radiculopathy. Most studies to date have been retrospective, or technically focused. Objective: To complete a randomized, blinded, prospective outcome study of the short-term benefit for IL versus TF epidural steroids for the treatment of subacute lumbar radicular pain. Study design: Prospective, randomized, blinded, subacute efficacy trial. Setting: Tertiary care pain management center, major metropolitan city, United States Methods: After institutional review board approval, 42 age-matched patients with similar lower back pain and unilateral radicular symptoms were enrolled and randomized in a patient and evaluating physician blinded trial to IL or TF epidural steroids from 2007 through 2009. Prior to intervention and 10-16 days after injection, each participant was evaluated by questionnaire and physical exam by an independent physician. All injections were performed by the same physician. Thirty-eight participants completed the study, 18 in the IL group and 20 in the TF group. Four participants required a repeat injection, and 2 participants crossed over to the alternative injection type (IL to TF). Results: Overall, physical exam, diagnostic testing, disability, activity, depression measures, and opioid pill use were similar between the 2 groups, both pre-injection baseline and postinjection improvement. In primary outcomes, the post-injection follow-up Numeric Rating Scale (NRS) was more greatly reduced in the TF group. The NRS decreased from 7.0 ± 1.9 to 3.9 ± 3.1 (mean values +/- standard deviation) in the IL group and 6.4 ± 2.1 to 1.7 ± 1.4 in the TF group. The Oswestry Disability Index was reduced from 37.5 ± 12.6 to 19.0 ± 16.7 in the IL group and 38.3 ± 6.4 to 21.6 ± 16.8 in the TF group. In secondary outcomes, the depression scale was reduced from 4.39 ± 3.22 to 2.28 ± 3.20 in the IL group and 4.10 ± 1.94 to 1.65 ± 1.63 in the TF group. Walking tolerance was increased from 8.1 ± 4.6 blocks to 10.6 ± 4.4 in the IL group and 8.9 ± 5.3 blocks to 11.8 ± 4.2 in the TF group. Limitations: The study did not examine long-term outcomes. A single experienced interventionalist performed all injections. Conclusion: Results suggest that patients may experience greater subjective relief, at least initially, from TF epidural steroid injections over IL. However, more objective, and likely subacute, therapeutic effects are similar. Key words: epidural, steroids, interlaminar, transforaminal, lumbar, lumbosacral, radicular, low back pain

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