Axial low back pain: one painful area--many perceptions and mechanisms

PLoS One. 2013 Jul 2;8(7):e68273. doi: 10.1371/journal.pone.0068273. Print 2013.

Abstract

Axial low back pain can be considered as a syndrome with both nociceptive and neuropathic pain components (mixed-pain). Especially neuropathic pain comprises a therapeutic challenge in practical experience and may explain why pharmacotherapy in back pain is often disappointing for both the patient and the therapist. This survey uses epidemiological and clinical data on the symptomatology of 1083 patients with axial low back pain from a cross sectional survey (painDETECT). Objectives were (1) to estimate whether neuropathic pain contributes to axial low back pain and if so to what extent. (2) To detect subgroups of patients with typical sensory symptom profiles and to analyse their demographic data and co-morbidities. (3) To compare patients with and without prior intervertebral disc surgery (IVD). Neuropathic pain components could be detected in 12% of the entire cohort. Cluster analyses of these patients revealed five distinct subgroups of patients showing a characteristic sensory profile, i.e. a typical constellation and combination of symptoms. All subgroups occurred in relevant numbers and some showed distinct neuropathic characteristics while others showed nociceptive features. Post-IVD-surgery patients showed a tendency to score more "neuropathic" than patients without surgery (not statistically significant). Axial low back pain has a high prevalence of co-morbidities with implication on therapeutic aspects. From these data it can be concluded that sensory profiles based on descriptor severity may serve as a better predictor for therapy assessment than pain intensity or sole diagnosis alone. Standardized phenotyping of pain symptoms with easy tools may help to develop an individualized therapy leading to a higher success rate in pharmacotherapy of axial low back pain.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cluster Analysis
  • Comorbidity
  • Cross-Sectional Studies
  • Diskectomy / statistics & numerical data
  • Female
  • Germany / epidemiology
  • Humans
  • Low Back Pain / diagnosis
  • Low Back Pain / epidemiology
  • Low Back Pain / physiopathology*
  • Male
  • Middle Aged
  • Neuralgia / diagnosis
  • Neuralgia / epidemiology
  • Neuralgia / physiopathology*
  • Outpatients / classification
  • Outpatients / statistics & numerical data*
  • Pain Measurement / classification
  • Pain Measurement / methods
  • Prevalence
  • Surveys and Questionnaires*

Grant support

This research was supported by a grant from Pfizer Germany without restriction on publication. Data was collected within the PainDetect project, which was funded by Pfizer. The funder had no role in study design, analysis, decision to publish, or preparation of the manuscript.