Sima Stone, Lapkin Samuel, Gan Zachary, Diwan Ashish D
Spine Labs, St George and Sutherland Clinical School, University of New South Wales, NSW, Australia.
Faculty of Health, Southern Cross University, Bilinga, QLD, Australia.
Global Spine J. 2025 May;15(4):1985-1991. doi: 10.1177/21925682241276441. Epub 2024 Aug 12.
Study DesignProspective cohort study.ObjectiveUnderstanding the complex nature of low back pain (LBP) is crucial for effective management. The PainDETECT questionnaire is a tool that distinguishes between neuropathic (NeP) and nociceptive (NoP) low back pain. Traditionally NeP and NoP have been primarily attributed to patho-anatomical abnormalities within the lumbar spine. However, increasing evidence points to multifaceted involvement, encompassing a range of physical, biomechanical, chemical, and psychosocial factors. The study aimed to determine the independent relationship between NeP as assessed by the PainDETECT questionnaire and non-spinal comorbid medical conditions.MethodsA prospective cohort study was conducted involving 400 patients suffering from chronic LBP (>6months), aged >18 years, who complete the PainDETECT questionnaire and provided responses regarding the presence of any comorbid conditions. A binary logistic regression model was used to analyse the confounding status of comorbid medical conditions and pain severity measured by NRS to determine independent relationships between specific conditions and neuropathic pain.ResultsThe study included 143 and 257 patients suffering from NeP and NoP, respectively. The NeP group had a 38% higher mean numerical rating scale score compared to the NoP group (8.10 1.55 vs 5.86 2.26, < 0.001). The odds of developing NeP were 2.9 Exp(B) = 2.844, 95%C.I. [1.426-5.670], < 0.01), 2.7 (Exp(B) = 2.726, 95%C.I. [1.183-6.283], < 0.05) and 2.8 (Exp(B) = 2.847, 95%C.I. [1.473-5.503], < 0.05) times higher in patients suffering from gastrointestinal conditions, rheumatoid arthritis, and depression, respectively.ConclusionNeP as determined by the PainDETECT questionnaire, is associated with gastrointestinal conditions, rheumatoid arthritis, and depression. This pioneering study has shed light on the potential involvement of the gut microbiome as a common factor connecting non-spinal comorbidities and NeP. These findings underscore the importance of formulating personalized management plans tailored to individual pain and medical profiles, rather than relying on a blanket approach to pain management.
研究设计
前瞻性队列研究。
目的
了解腰痛（LBP）的复杂本质对于有效管理至关重要。疼痛检测问卷是一种区分神经性（NeP）和伤害性（NoP）腰痛的工具。传统上，NeP和NoP主要归因于腰椎内的病理解剖异常。然而，越来越多的证据表明存在多方面的影响因素，包括一系列身体、生物力学、化学和心理社会因素。本研究旨在确定通过疼痛检测问卷评估的NeP与非脊柱合并症之间的独立关系。
方法
进行了一项前瞻性队列研究，纳入400例患有慢性腰痛（>6个月）、年龄>18岁的患者，他们完成了疼痛检测问卷并提供了有关任何合并症存在情况的回答。使用二元逻辑回归模型分析合并症的混杂状态以及用数字评分量表（NRS）测量的疼痛严重程度，以确定特定疾病与神经性疼痛之间的独立关系。
结果
该研究分别纳入了143例和257例患有NeP和NoP的患者。NeP组的平均数字评分量表得分比NoP组高38%（8.10±1.55对5.86±2.26，P<0.001）。患有胃肠道疾病、类风湿性关节炎和抑郁症的患者发生NeP的几率分别高2.9倍（Exp(B)=2.844，95%置信区间[1.426 - 5.670]，P<0.01）、2.7倍（Exp(B)=2.726，95%置信区间[1.183 - 6.283]，P<0.05）和2.8倍（Exp(B)=2.847，95%置信区间[1.473 - 5.503]，P<0.05）。
结论
通过疼痛检测问卷确定的NeP与胃肠道疾病、类风湿性关节炎和抑郁症相关。这项开创性研究揭示了肠道微生物群作为连接非脊柱合并症和NeP的共同因素的潜在作用。这些发现强调了制定针对个体疼痛和医疗状况的个性化管理计划的重要性，而不是依赖统一的疼痛管理方法。
