Yamashita Toshihiko, Takahashi Kazuhisa, Yonenobu Kazuo, Kikuchi Shin-ichi
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan,
J Orthop Sci. 2014 Jan;19(1):15-21. doi: 10.1007/s00776-013-0496-9. Epub 2013 Dec 5.
The incidence and characteristics of neuropathic pain associated with spinal disorders have not yet been fully clarified. The purpose of this study was to investigate the prevalence of neuropathic pain and the degree of deterioration of quality of life (QOL) in patients with chronic pain associated with spinal disorders who visited orthopedic outpatient clinics.
This cross-sectional study was conducted in 1,857 patients recruited from 137 medical institutions nationwide. Participants were men and women aged 20-79 years with a history of spine-related pain for at least 3 months and a visual analog scale (VAS) score of at least 30 in the previous week. Patients were screened using a neuropathic pain screening questionnaire. The degree of QOL deterioration and its correlation with the presence of neuropathic pain were assessed using the Short Form Health Survey with 36 questions (SF-36).
Overall prevalence of neuropathic pain was 53.3%. It was relatively high in patients with cervical spondylotic myelopathy (77.3%) and ligament ossification (75.7%) and relatively low in those with low back pain (29.4%) and spondylolysis (40.4%). Only 56.9% of patients with radiculopathy were diagnosed with neuropathic pain. Logistic regression analysis identified several risk factors, including advanced age, severe pain, disease duration of at least 6 months, and cervical lesions. In QOL assessment, physical functioning, role-physical, role-emotional, and social functioning were severely affected, and this trend was more pronounced in patients who were more likely to have neuropathic pain.
The frequency of neuropathic pain tended to be higher in patients with diseases associated with spinal cord damage and lower in patients with diseases that primarily manifested as somatic pain. A bias toward allodynia symptoms in the screening questionnaire may have resulted in the failure to diagnose neuropathic pain in some patients with radiculopathy. Poor QOL, primarily from the aspect of physical functioning, was demonstrated in patients with neuropathic pain associated with spinal disorders.
与脊柱疾病相关的神经性疼痛的发病率和特征尚未完全阐明。本研究的目的是调查在骨科门诊就诊的慢性脊柱疾病相关疼痛患者中神经性疼痛的患病率以及生活质量（QOL）的恶化程度。
这项横断面研究纳入了从全国137家医疗机构招募的1857名患者。参与者为年龄在20 - 79岁之间的男性和女性，有至少3个月的脊柱相关疼痛病史，且前一周视觉模拟量表（VAS）评分至少为30分。使用神经性疼痛筛查问卷对患者进行筛查。使用36个问题的简短健康调查问卷（SF - 36）评估生活质量恶化程度及其与神经性疼痛存在的相关性。
神经性疼痛的总体患病率为53.3%。在脊髓型颈椎病患者（77.3%）和韧带骨化患者（75.7%）中相对较高，而在腰痛患者（29.4%）和椎弓根峡部裂患者（40.4%）中相对较低。仅有56.9%的神经根病患者被诊断为神经性疼痛。逻辑回归分析确定了几个危险因素，包括高龄、严重疼痛、病程至少6个月以及颈椎病变。在生活质量评估中，身体功能、角色 - 身体、角色 - 情感和社会功能均受到严重影响，并且这种趋势在更可能患有神经性疼痛的患者中更为明显。
与脊髓损伤相关疾病的患者中神经性疼痛的发生率往往较高，而主要表现为躯体疼痛的疾病患者中发生率较低。筛查问卷中对异常性疼痛症状的偏向可能导致一些神经根病患者未能被诊断为神经性疼痛。与脊柱疾病相关的神经性疼痛患者表现出生活质量较差，主要体现在身体功能方面。
