Kim Jin-Hwan, Hong Jae Taek, Lee Chong-Suh, Kim Keun-Su, Suk Kyung-Soo, Kim Jin-Hyok, Park Ye-Soo, Chang Bong-Soon, Jun Deuk Soo, Kim Young-Hoon, Lee Jung-Hee, Min Woo-Kie, Lee Jung-Sub, Park Si-Young, Oh In-Soo, Hong Jae-Young, Shin Hyun-Chul, Kim Woo-Kyung, Kim Joo-Han, Lee Jung-Kil, Kim In-Soo, Ha Yoon, Im Soo-Bin, Kim Sang Woo, Han In-Ho, Shin Jun-Jae, Rim Byeong Cheol, Seo Bo-Jeong, Kim Young-Joo, Lee Juneyoung
Department of Orthopedic Surgery , Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Asian Spine J. 2017 Dec;11(6):917-927. doi: 10.4184/asj.2017.11.6.917. Epub 2017 Dec 7.
A noninterventional, multicenter, cross-sectional study.
We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP).
Among patients with CLBP, 20%-55% had NP.
Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4<4) groups.
A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%-43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; <0.01), in patients who had pain based on radiological and neurological findings (59.0%; <0.01), and in patients who had severe pain (49.0%; <0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; <0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; <0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=-0.1; <0.01) and higher QBPDS (β=7.0; <0.01) scores than those without NP.
NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
一项非干预性、多中心横断面研究。
我们调查了韩国慢性下腰痛（CLBP）成年患者中神经性疼痛（NP）的患病率以及患者报告的生活质量（QoL）和功能障碍结局（PROs）。
在CLBP患者中，20%-55%患有NP。
2014年12月至2015年5月期间，从27家综合医院招募年龄大于20岁、CLBP持续时间超过三个月、视觉模拟量表（VAS）疼痛评分高于4分且在入组前至少使用了四周止痛药物的患者。进行病历审查以收集人口统计学/临床特征以及NP诊断（神经病理性疼痛4，DN4）。通过患者调查确定QoL（欧洲五维健康量表，EQ-5D；EQ-视觉模拟量表）和功能障碍（魁北克腰痛残疾量表，QBPDS）。进行多元线性回归分析以比较NP组（DN4≥4）和非NP组（DN4<4）之间的PROs。
共纳入1200例患者（女性：65.7%；平均年龄：63.4±13.0岁）。EQ-5D、EQ-视觉模拟量表和QBPDS的平均得分分别为0.5±0.3、55.7±19.4和40.4±21.1。在所有患者中，492例（41.0%；95%置信区间，38.2%-43.8%）患有NP。男性患者（46.8%；<0.01）、基于放射学和神经学检查结果有疼痛的患者（59.0%；<0.01）以及有严重疼痛的患者（49.0%；<0.01）中NP的患病率更高。EQ-5D（NP组与非NP组：0.4±0.3 vs. 0.5±0.3；<0.01）和QBPDS（NP组与非NP组：45.8±21.2 vs. 36.3±20.2；<0.01）得分存在显著平均差异。在多元线性回归中，与无NP的患者相比，有NP的患者EQ-5D得分更低（β=-0.1；<0.01），QBPDS得分更高（β=7.0；<0.01）。
NP在韩国CLBP患者中高度流行。患有NP（神经性疼痛）的CLBP患者的生活质量低于无NP的患者，功能障碍更严重。为提高CLBP患者的生活质量和功能状态，本研究强调了正确诊断和治疗NP的重要性。
