Highlights
- •Twelve studies were included in the review of low back-related leg pain patients (LBLP).
- •Prevalence estimates of neuropathic pain in LBLP patients varied from 19% to 80%.
- •LBLP patients with neuropathic pain had worse disability compared to those without.
- •On the basis of 1 study, prognosis was worse for LBLP patients with neuropathic pain.
- •No evidence was found on characteristics associated with prognosis (prognostic factors).
Abstract
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.
Perspective
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.
Key words
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Article info
Publication history
Published online: June 14, 2017
Footnotes
Sarah A. Harrisson, MSc, is a Clinical Doctoral Fellow, and Nadine E. Foster is a National Institute for Health Research (NIHR) Research Professor, and NIHR Senior Investigator; both were supported through an NIHR Research Professorship awarded to Nadine E. Foster (NIHR-RP-011-015). Siobhan Stynes is funded by an NIHR/Chief Nursing Officer Clinical Doctoral Research Fellowship (CDRF-2010-055). Kika Konstantinou is supported by a Higher Education Funding Council for England/NIHR Senior Clinical Lectureship. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the NIHR, or the Department of Health.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2017 Published by Elsevier Inc. on behalf of the American Pain Society
