Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom.
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom.
J Pain. 2017 Nov;18(11):1295-1312. doi: 10.1016/j.jpain.2017.04.012. Epub 2017 Jun 12.
This systematic review synthesizes literature describing prevalence, characteristics, and prognosis of low back-related leg pain (LBLP) patients with neuropathic pain in primary care and/or similar settings. Inclusion and exclusion criteria were developed and used by independent reviewers to screen citations for eligibility. The initial search yielded 24,948 citations; after screening 12 studies were included. Neuropathic pain was identified using case ascertainment tools (n = 5), clinical history with examination (n = 4), and using LBLP samples assumed neuropathic (n = 3). Neuropathic pain prevalence varied from 19% to 80%. There was consistent evidence for higher back-related disability (n = 3), poorer health-related quality of life (n = 2), and some evidence for more severe depression (n = 2), anxiety (n = 3), and pain intensity (n = 4) in patients with neuropathic pain. Results were less consistent when cases were identified through clinical history with examination than those identified using case ascertainment tools. Prognosis (n = 1) of LBLP patients with neuropathic pain was worse compared with those without, in all outcomes (leg pain intensity, leg and back-related disability, self-reported general health) except back pain intensity. No studies described prognostic factors. This systematic review highlights the evidence gap in neuropathic pain in LBLP in primary care, especially with respect to prognosis.
Patients with LBLP may have neuropathic pain. This systematic review emphasizes the paucity of evidence describing the characteristics and prognosis of neuropathic pain in this patient population. Future research investigating prognosis of these patients with neuropathic pain is likely to contribute to better understanding and management.
本系统评价综合了描述初级保健和/或类似环境中患有神经根性下肢痛（LBLP）的伴有神经病理性疼痛的患者的患病率、特征和预后的文献。纳入和排除标准由独立审查员制定和使用，以筛选合格的引文。最初的搜索产生了 24948 条引文；经过筛选，有 12 项研究被纳入。使用病例确定工具（n=5）、临床病史和检查（n=4）以及假设患有神经根性下肢痛的样本（n=3）来确定神经病理性疼痛。神经病理性疼痛的患病率从 19%到 80%不等。有充分的证据表明，伴有神经病理性疼痛的患者的腰痛相关残疾程度更高（n=3），健康相关生活质量更差（n=2），一些证据表明，伴有神经病理性疼痛的患者的抑郁程度（n=2）、焦虑程度（n=3）和疼痛强度（n=4）更严重。通过临床病史和检查确定病例的结果不如使用病例确定工具确定病例的结果一致。与无神经病理性疼痛的患者相比，伴有神经病理性疼痛的 LBLP 患者的预后（n=1）在所有结局（下肢疼痛强度、下肢和腰痛相关残疾、自我报告的总体健康状况）均较差，除腰痛强度外。没有研究描述预后因素。本系统评价突出了初级保健中 LBLP 中神经病理性疼痛的证据差距，特别是在预后方面。
患有 LBLP 的患者可能患有神经病理性疼痛。本系统评价强调了缺乏描述该患者人群中神经病理性疼痛特征和预后的证据。未来研究调查这些伴有神经病理性疼痛的患者的预后可能有助于更好地理解和管理。
