Konstantinou Kika, Dunn Kate M, Ogollah Reuben, Vogel Steven, Hay Elaine M
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
British School of Osteopathy, London, UK.
BMC Musculoskelet Disord. 2015 Nov 4;16:332. doi: 10.1186/s12891-015-0787-8.
Patients with back pain radiating to the leg(s) report worse symptoms and poorer recovery than those with back pain alone. Robust evidence regarding their epidemiological profile is lacking from primary care, the setting where most of these patients will present and be managed. Our objective was to describe the characteristics of patients with back and leg pain, including sciatica, seeking treatment in primary care.
Adults visiting their general practitioner with back and leg pain, of any duration and severity, were invited to participate. Participants completed questionnaires, underwent clinical assessments and received MRI scans. Characteristics of the sample are described, and differences between patients diagnosed with referred leg pain and those with sciatica are analysed.
Six hundred nine patients participated; 62.6 % were female, mean (SD) age 50.2 (13.9). 67.5 % reported pain below the knee, 60.7 % were in paid employment with 39.7 % reporting time off work. Mean disability (RMDQ) was 12.7 (5.7) and mean pain intensity was 5.6 (2.2) and 5.2 (2.4) for back and leg respectively. Mean sciatica bothersomeness index (SBI) was 14.9 (5.1). Three quarters (74.2 %) were clinically diagnosed as having sciatica. In the sciatica group, leg pain intensity, neuropathic pain, pain below the knee, leg pain worse than back pain, SBI and positive MRI findings were significantly higher as compared to patients with referred leg pain.
This primary care cohort reported high levels of disability and pain. This is the first epidemiological study of unselected primary care patients seeking healthcare for back and leg pain. Follow-up of this cohort will investigate the prognostic value of their baseline characteristics. This new information will contribute to our understanding of the characteristics and clinical features of this population, and will underpin future research aimed at defining prognostic subgroups to enable better targeting of health care provision.
与单纯背痛患者相比，腿痛放射至腿部的背痛患者报告的症状更严重，恢复情况更差。初级保健领域缺乏关于这些患者流行病学特征的有力证据，而大多数此类患者正是在初级保健机构就诊和接受治疗。我们的目的是描述在初级保健机构寻求治疗的背痛伴腿痛（包括坐骨神经痛）患者的特征。
邀请因背痛伴腿痛前来全科医生处就诊的成年人参与，疼痛持续时间和严重程度不限。参与者完成问卷调查，接受临床评估并进行磁共振成像（MRI）扫描。描述样本特征，并分析诊断为牵涉性腿痛患者与坐骨神经痛患者之间的差异。
609名患者参与研究；62.6%为女性，平均（标准差）年龄50.2（13.9）岁。67.5%报告膝关节以下疼痛，60.7%有带薪工作，其中39.7%报告曾请假。平均残疾程度（RMDQ）为12.7（5.7），背部和腿部的平均疼痛强度分别为5.6（2.2）和5.2（2.4）。平均坐骨神经痛困扰指数（SBI）为14.9（5.1）。四分之三（74.2%）的患者临床诊断为坐骨神经痛。与牵涉性腿痛患者相比，坐骨神经痛组的腿痛强度、神经性疼痛、膝关节以下疼痛、腿痛比背痛更严重、SBI以及MRI阳性结果显著更高。
这个初级保健队列报告了较高程度的残疾和疼痛。这是对未经选择的因背痛伴腿痛寻求医疗保健的初级保健患者进行的首次流行病学研究。对该队列的随访将调查其基线特征的预后价值。这些新信息将有助于我们了解该人群的特征和临床特点，并为未来旨在确定预后亚组以更好地针对性提供医疗保健的研究奠定基础。
