Clinic for Rehabilitation "Dr. M. Zotovic", Belgrade, Serbia -
Faculty of Medicine, University of Belgrade, Belgrade, Serbia -
Eur J Phys Rehabil Med. 2019 Apr;55(2):217-224. doi: 10.23736/S1973-9087.18.05226-7. Epub 2018 Oct 22.
Neuropathic pain in early chronic low back pain is insufficiently recognized and treated.
The aim of this study was to establish if there is a difference among chronic low back pain subjects with and without neuropathic pain and healthy subjects, in clinical characteristic and the level of trunk muscle activation.
Cross sectional observational study.
Rehabilitation clinic, inpatient and outpatient.
Thirty-three subjects in early chronic phase of low back pain and 26 healthy subjects were included in this research.
Clinical characteristics and relative thickness change of lumbar multifidus and transversal abdominal muscle, measured by ultrasound, in neuropathic, non-neuropathic chronic low back pain and healthy subjects were analyzed.
Chronic low back pain subjects with neuropathic pain reported higher level of pain on Visual Analog Scale (VAS) (back pain P=0.016, leg pain P=0.006), had higher Oswestry Disability Score (P=0.029), had lower motor (P=0.001) and sensory leg scores (P=0.000), and decreased level of activation of transversal abdominal muscle (P=0.000) comparing to chronic low back pain group without neuropathic pain. Low back pain subjects with leg pain ≥5 on VAS were 11.2 times more prone to develop neuropathic pain. Motor leg score ≤47 increases this chance 35 times. Sensory leg score ≤25 increases this chance 14 times. Reduced activation of transversal abdominal muscle for 40-50% increases this chance 7-24 times.
Chronic low back pain subjects with neuropathic pain were more painful and disabled, had lower motor and sensory scores, and lower relative thickness change of transversal abdominal muscle comparing to the low back pain group without neuropathic pain. Self -reported leg pain intensity of 5 or more on VAS, motor score of 47 and less, sensory scores of 25 and less and diminished activation of transversal abdominal muscle significantly increase the chance that chronic low back pain subject has neuropathic component of pain.
Neuropathic pain in early chronic low back pain subjects might be more readily recognized if patients with radiculopathy and diminished activation of transversal abdominal muscle were regularly screened for neuropathic pain.
早期慢性腰痛中的神经性疼痛未得到充分认识和治疗。
本研究旨在确定慢性腰痛患者中是否存在有和没有神经性疼痛以及健康受试者之间的差异，在临床特征和躯干肌肉激活水平方面。
横断面观察性研究。
康复诊所，住院和门诊。
33 名慢性腰痛早期患者和 26 名健康受试者纳入本研究。
通过超声分析神经性、非神经性慢性腰痛患者和健康受试者的腰椎多裂肌和横腹肌的相对厚度变化和临床特征。
患有神经性疼痛的慢性腰痛患者报告的视觉模拟量表（VAS）疼痛水平更高（背部疼痛 P=0.016，腿部疼痛 P=0.006），Oswestry 残疾评分更高（P=0.029），运动（P=0.001）和感觉（P=0.000）腿部评分较低，横腹肌的激活水平降低（P=0.000）。VAS 腿部疼痛≥5 的慢性腰痛患者发生神经性疼痛的可能性增加 11.2 倍。运动腿部评分≤47 使这种可能性增加 35 倍。感觉腿部评分≤25 使这种可能性增加 14 倍。横腹肌激活减少 40-50%使这种可能性增加 7-24 倍。
患有神经性疼痛的慢性腰痛患者比没有神经性疼痛的慢性腰痛患者更疼痛和残疾，运动和感觉评分较低，横腹肌的相对厚度变化较小。VAS 报告的腿部疼痛强度为 5 或更高，运动评分≤47，感觉评分≤25 和横腹肌激活明显减少，显著增加慢性腰痛患者患有神经性疼痛的可能性。
如果定期对神经根病和横腹肌激活减少的患者进行神经性疼痛筛查，可能会更易于识别早期慢性腰痛患者中的神经性疼痛。
