Research Department, Spine Centre of Southern Denmark, Middelfart, Denmark.
Clin J Pain. 2011 Jul-Aug;27(6):535-41. doi: 10.1097/AJP.0b013e318208c941.
This study was designed to investigate whether the PainDETECT Questionnaire (PDQ) classification was predictive of outcomes at 3 and 12 months follow-up in low back pain (LBP) patients with associated leg pain. Identification of clinically important subgroups and targeted treatment is believed to be important in LBP care. The PD-Q is designed to classify whether a person has neuropathic pain, based on their self-reported pain characteristics. However, it is unknown whether this classification is a prognostic factor or predicts treatment response.
One hundred forty-five participants were recruited in the secondary care. Inclusion criteria were 3 to 12 months of LBP and related leg pain. Baseline PDQ scores classified participants into 3 groups ("likely" to have neuropathic pain, "uncertain," and "unlikely") but did not affect treatment decisions. The outcome measures were LBP, leg pain, activity limitation, and self-reported general health. Scores were compared between those with "likely" neuropathic pain (neuropathic group) and "unlikely" (non-neuropathic group), using Mann-Whitney, Friedman, and χ tests.
At baseline, the neuropathic group had worse scores on all outcome measures, and analgesic use, sick leave, and sense of coherence (P = 0.000 to 0.044). At 3 months and 12 months, both groups improved (P = 0.001 to 0.032). However, the groups remained different at each time point on all outcome measures (P = 0.000 to 0.033) except LBP (P = 0.054 to 0.214).
The PDQ classification was a prognostic factor but was not predictive of response to treatment that was not targeted to neuropathic pain. Further studies should investigate whether PD-Q groups are predictive of treatment response when targeted to neuropathic pain.
本研究旨在探讨疼痛 DETECT 问卷（PDQ）分类在伴有下肢疼痛的慢性腰痛（LBP）患者的 3 个月和 12 个月随访中是否具有预测结果的能力。在 LBP 护理中，识别具有临床重要意义的亚组和针对性治疗被认为是很重要的。PD-Q 旨在根据患者自我报告的疼痛特征，对是否存在神经病理性疼痛进行分类。然而，尚不清楚这种分类是否是预后因素或预测治疗反应的因素。
在二级医疗机构共招募了 145 名参与者。纳入标准为 3 至 12 个月的 LBP 和相关下肢疼痛。PDQ 基线评分将参与者分为 3 组（“可能”存在神经病理性疼痛、“不确定”和“不太可能”），但不影响治疗决策。结局指标包括 LBP、下肢疼痛、活动受限和自我报告的总体健康状况。使用 Mann-Whitney、Friedman 和 χ2 检验比较神经病理性疼痛（神经病理性组）和非神经病理性疼痛（非神经病理性组）之间的评分差异。
在基线时，神经病理性组在所有结局指标上的评分均较差，且在使用镇痛药、请病假和感到生活有意义方面的比例也较高（P = 0.000 至 0.044）。在 3 个月和 12 个月时，两组均有改善（P = 0.001 至 0.032）。然而，在每个时间点，两组在所有结局指标上仍存在差异（P = 0.000 至 0.033），除了 LBP（P = 0.054 至 0.214）。
PDQ 分类是一个预后因素，但对非针对神经病理性疼痛的治疗反应没有预测作用。进一步的研究应探讨 PD-Q 组在针对神经病理性疼痛的治疗反应时是否具有预测作用。
