Yonsei Med J.  2015 Jul;56(4):1044-1050. 10.3349/ymj.2015.56.4.1044.

Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

Affiliations
  • 1Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, Korea. drspine90@gmail.com
  • 2Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
  • 3Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Orthopedic Surgery, The Second Hospital of Xiangya, Central South University, Changsha, Hunan, P.R. China.

Abstract

PURPOSE
To determine the prevalence and characteristics of neuropathic pain (NP) in patients with lumbar spinal stenosis (LSS) according to subgroup analysis of symptoms.
MATERIALS AND METHODS
We prospectively enrolled subjects with LSS (n=86) who were scheduled to undergo spinal surgery. The patients were divided into two groups according to a chief complaint of radicular pain or neurogenic claudication. We measured patient's pain score using the visual analog scale (VAS), Oswestry Disability Index (ODI) and Leads Assessment of Neuropathic Symptoms and Signs (LANSS). According to LANSS value, the prevalence of NP component pain in patients with LSS was assessed. Statistical analysis was performed to find the relationship between LANSS scores and the other scores.
RESULTS
From our sample of 86 patients, 31 (36.0%) had a NP component, with 24 (63.4%) in the radicular pain group having NP. However, only seven patients (15.6%) in the neurogenic claudication group had NP. The LANSS pain score was not significantly correlated with VAS scores for back pain, but did correlate with VAS scores for leg pain (R=0.73, p<0.001) and with ODI back pain scores (R=0.54, p<0.01).
CONCLUSION
One-third of the patients with LSS had a NP component. The presence of radicular pain correlated strongly with NP. The severity of leg pain and ODI score were also closely related to a NP component. This data may prove useful to understanding the pain characteristics of LSS and in better designing clinical trials for NP treatment in patients with LSS.

Keyword

Neuropathic pain; spinal stenosis; visual analog scale; Oswestry Disability Index; Leads Assessment of Neuropathic Symptoms and Signs

MeSH Terms

Adult
Aged
Back Pain
Decompression, Surgical
Disability Evaluation
Female
Humans
*Lumbar Vertebrae/surgery
Male
Middle Aged
Neuralgia/*complications/epidemiology
Outcome Assessment (Health Care)
Pain Measurement/*methods
Prevalence
Prospective Studies
Republic of Korea/epidemiology
Severity of Illness Index
Spinal Stenosis/epidemiology/*surgery
Surveys and Questionnaires
Treatment Outcome

Figure

  • Fig. 1 Proportion of patients with neuropathic pain by group (neuropathic pain was defined as a LANSS score greater than or equal to 12). LANSS, Leads Assessment of Neuropathic Symptoms and Signs.


Reference

1. Merskey H, Bogduk H. Classification of Chronic Pain: descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle (DC): IASP Press;1994.
2. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008; 136:380–387.
Article
3. Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976). 1987; 12:264–268.
Article
4. Freynhagen R, Baron R. The evaluation of neuropathic components in low back pain. Curr Pain Headache Rep. 2009; 13:185–190.
Article
5. Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006; 22:1911–1920.
Article
6. Attal N, Cruccu G, Haanpää M, Hansson P, Jensen TS, Nurmikko T, et al. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol. 2006; 13:1153–1169.
Article
7. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010; 17:1113–e88.
Article
8. Hall S, Bartleson JD, Onofrio BM, Baker HL Jr, Okazaki H, O'Duffy JD. Lumbar spinal stenosis. Clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Ann Intern Med. 1985; 103:271–275.
9. Epstein NE, Maldonado VC, Cusick JF. Symptomatic lumbar spinal stenosis. Surg Neurol. 1998; 50:3–10.
10. Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976). 2011; 36:E1335–E1351.
11. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976). 2005; 30:1441–1445.
Article
12. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008; 358:794–810.
Article
13. Rados I, Sakic Zdravcevic K, Hrgovic Z. painDETECT questionnaire and lumbar epidural steroid injection for chronic radiculopathy. Eur Neurol. 2013; 69:27–32.
Article
14. Attal N, Perrot S, Fermanian J, Bouhassira D. The neuropathic components of chronic low back pain: a prospective multicenter study using the DN4 Questionnaire. J Pain. 2011; 12:1080–1087.
Article
15. Mahn F, Hüllemann P, Gockel U, Brosz M, Freynhagen R, Tölle TR, et al. Sensory symptom profiles and co-morbidities in painful radiculopathy. PLoS One. 2011; 6:e18018.
Article
16. Genevay S, Atlas SJ, Katz JN. Variation in eligibility criteria from studies of radiculopathy due to a herniated disc and of neurogenic claudication due to lumbar spinal stenosis: a structured literature review. Spine (Phila Pa 1976). 2010; 35:803–811.
Article
17. Steurer J, Roner S, Gnannt R, Hodler J. LumbSten Research Collaboration. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord. 2011; 12:175.
Article
18. Jeon CH, Kim DJ, Kim SK, Kim DJ, Lee HM, Park HJ. Validation in the cross-cultural adaptation of the Korean version of the Oswestry Disability Index. J Korean Med Sci. 2006; 21:1092–1097.
Article
19. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001; 92:147–157.
Article
20. Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, et al. Using screening tools to identify neuropathic pain. Pain. 2007; 127:199–203.
Article
21. Kaki AM, El-Yaski AZ, Youseif E. Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Reg Anesth Pain Med. 2005; 30:422–428.
Article
22. Amundsen T, Weber H, Lilleås F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis. Clinical and radiologic features. Spine (Phila Pa 1976). 1995; 20:1178–1186.
23. Khedr EM, Kotb H, Kamel NF, Ahmed MA, Sadek R, Rothwell JC. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry. 2005; 76:833–838.
Article
24. Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009; 9:545–550.
Article
25. Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008; 358:818–825.
26. Takahashi K, Kagechika K, Takino T, Matsui T, Miyazaki T, Shima I. Changes in epidural pressure during walking in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 1995; 20:2746–2749.
Article
27. Kobayashi S, Baba H, Uchida K, Kokubo Y, Kubota C, Yamada S, et al. Effect of mechanical compression on the lumbar nerve root: localization and changes of intraradicular inflammatory cytokines, nitric oxide, and cyclooxygenase. Spine (Phila Pa 1976). 2005; 30:1699–1705.
Article
28. Kobayashi S, Kokubo Y, Uchida K, Yayama T, Takeno K, Negoro K, et al. Effect of lumbar nerve root compression on primary sensory neurons and their central branches: changes in the nociceptive neuropeptides substance P and somatostatin. Spine (Phila Pa 1976). 2005; 30:276–282.
Article
29. Freynhagen R, Baron R, Tölle T, Stemmler E, Gockel U, Stevens M, et al. Screening of neuropathic pain components in patients with chronic back pain associated with nerve root compression: a prospective observational pilot study (MIPORT). Curr Med Res Opin. 2006; 22:529–537.
Article
30. Merskey H. Clarifying definition of neuropathic pain. Pain. 2002; 96:408–409.
Article
31. Vranken JH. Mechanisms and treatment of neuropathic pain. Cent Nerv Syst Agents Med Chem. 2009; 9:71–78.
Article
32. Moulin DE, Clark AJ, Gilron I, Ware MA, Watson CP, Sessle BJ, et al. Pharmacological management of chronic neuropathic pain - consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag. 2007; 12:13–21.
Article
33. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008; 71:1183–1190.
Article
34. Jensen TS, Madsen CS, Finnerup NB. Pharmacology and treatment of neuropathic pains. Curr Opin Neurol. 2009; 22:467–474.
Article
35. Baron R, Freynhagen R, Tölle TR, Cloutier C, Leon T, Murphy TK, et al. The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain. 2010; 150:420–427.
Article
36. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010; 9:807–819.
Article
37. Ammendolia C, Stuber K, de Bruin LK, Furlan AD, Kennedy CA, Rampersaud YR, et al. Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review. Spine (Phila Pa 1976). 2012; 37:E609–E616.
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr