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Neuropathic Pain in Low Back-Related Leg Pain Patients: What Is the Evidence of Prevalence, Characteristics, and Prognosis in Primary Care? A Systematic Review of the Literature

  • Sarah A. Harrisson
    Correspondence
    Address reprint requests to Sarah A. Harrisson, Arthritis Research UK Primary Care Centre, Stoke on Trent, Staffordshire ST5 5BG, United Kingdom.
    Affiliations
    Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
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  • Siobhán Stynes
    Affiliations
    Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
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  • Kate M. Dunn
    Affiliations
    Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
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  • Nadine E. Foster
    Affiliations
    Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
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  • Kika Konstantinou
    Affiliations
    Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
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      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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      References

      1. Altman DG, Ashby D, Birks J, Borenstein M, Campbell M, Deeks JJ, Egger M, Higgins JP, Lau J, O'Rourke K, Scholten R, Sterne J, Thompson S, Whitehead A: Chapter 9: Analysing data and undertaking meta-analyses, in Deeks JJ, Higgins JP, Altman DG (eds): Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available at: www.handbook.cochrane.org. Accessed March 7, 2017

        • Aminde L.N.
        • Dzudie A.
        • Kengne A.P.
        Prevalent diabetes mellitus in patients with heart failure and disease determinants in sub-Saharan Africans having diabetes with heart failure: A protocol for a systematic review and meta-analysis.
        BMJ Open. 2016; 6: e010097
        • Attal N.
        • Perrot S.
        • Fermanian J.
        • Bouhassira D.
        The neuropathic components of chronic low back pain: A prospective multicenter study using the DN4 Questionnaire.
        J Pain. 2011; 12: 1080-1087
        • Baron R.
        • Binder A.
        • Attal N.
        • Casale R.
        • Dickenson A.H.
        • Treede R.D.
        Neuropathic low back pain in clinical practice.
        Eur J Pain. 2016; 20: 861-873
        • Baron R.
        • Forster M.
        • Binder A.
        Subgrouping of patients with neuropathic pain according to pain-related sensory abnormalities: A first step to a stratified treatment approach.
        Lancet Neurol. 2012; 11: 999-1005
        • Beith D.
        • Kemp A.
        • Kenyon J.
        • Prout M.
        • Chestnut J.
        Identifying neuropathic back and leg pain: A cross-sectional study.
        Pain. 2011; 152: 1511
        • Bennett M.
        The LANSS Pain Scale: The Leeds assessment of neuropathic symptoms and signs.
        Pain. 2001; 92: 147-157
        • Bennett M.I.
        • Smith B.H.
        • Torrance N.
        • Potter J.
        The S-LANSS score for identifying pain of predominantly neuropathic origin: Validation for use in clinical and postal research.
        J Pain. 2005; 6: 149-158
        • Berger A.
        • Sadosky A.
        • Dukes E.
        • Edelsberg J.
        • Oster G.
        Clinical characteristics and patterns of healthcare utilization in patients with painful neuropathic disorders in UK general practice: A retrospective cohort study.
        BMC Neurol. 2012; 12: 8
        • Bouhassira D.
        • Attal N.
        • Alchaar H.
        • Boureau F.
        • Brochet B.
        • Bruxelle J.
        • Cunin G.
        • Fermanian J.
        • Ginies P.
        • Grun-Overdyking A.
        • Jafari-Schluep H.
        • Lantéri-Minet M.
        • Laurent B.
        • Mick G.
        • Serrie A.
        • Valade D.
        • Vicaut E.
        Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).
        Pain. 2005; 14: 29-36
        • Breivik H.
        • Collett B.
        • Ventafridda V.
        • Cohen R.
        • Gallacher D.
        Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment.
        Eur J Pain. 2006; 10: 287-333
        • Buchbinder R.
        • Blyth F.M.
        • March L.M.
        • Brooks P.
        • Woolf A.D.
        • Hoy D.G.
        Placing the global burden of low back pain in context.
        Best Pract Res Clin Rheumatol. 2013; 27: 575-589
        • Coggon D.
        • Ntani G.
        • Walker-Bone K.
        • Palmer K.T.
        • Felli V.E.
        • Harari R.
        • Barrero L.H.
        • Felknor S.A.
        • Gimeno D.
        • Cattrell A.
        • Vargas-Prada S.
        • Bonzini M.
        • Solidaki E.
        • Merisalu E.
        • Habib R.R.
        • Sadeghian F.
        • Kadir M.M.
        • Warnakulasuriya S.S.
        • Matsudaira K.
        • Nyantumbu B.
        • Sim M.R.
        • Harcombe H.
        • Cox K.
        • Sarquis L.M.
        • Marziale M.H.
        • Harari F.
        • Freire R.
        • Harari N.
        • Monroy M.V.
        • Quintana L.A.
        • Rojas M.
        • Harris E.C.
        • Serra C.
        • Martinez J.M.
        • Delclos G.
        • Benavides F.G.
        • Carugno M.
        • Ferrario M.M.
        • Pesatori A.C.
        • Chatzi L.
        • Bitsios P.
        • Kogevinas M.
        • Oha K.
        • Freimann T.
        • Sadeghian A.
        • Peiris-John R.J.
        • Sathiakumar N.
        • Wickremasinghe A.R.
        • Yoshimura N.
        • Kelsall H.L.
        • Hoe V.C.
        • Urquhart D.M.
        • Derrett S.
        • McBride D.
        • Herbison P.
        • Gray A.
        • Vega E.J.
        Epidemiological differences between localised and non-localised low back pain.
        Spine (Phila Pa 1976). 2017; 42: 740-747
        • Costa Lda C.
        • Koes B.W.
        • Pransky G.
        • Borkan J.
        • Maher C.G.
        • Smeets R.J.
        Primary care research priorities in low back pain: An update.
        Spine (Phila Pa 1976). 2013; 38: 148-156
        • Croft P.
        • Altman D.G.
        • Deeks J.J.
        • Dunn K.M.
        • Hay A.D.
        • Hemingway H.
        • LeResche L.
        • Peat G.
        • Perel P.
        • Petersen S.E.
        • Riley R.D.
        • Roberts I.
        • Sharpe M.
        • Stevens R.J.
        • Van Der Windt D.A.
        • Von Korff M.
        • Timmis A.
        The science of clinical practice: Disease diagnosis or patient prognosis? Evidence about “what is likely to happen” should shape clinical practice.
        BMC Med. 2015; 13: 20
        • Crombie I.K.
        • Davies H.T.
        Selection bias in pain research.
        Pain. 1998; 74: 1-3
        • de Andres J.
        • de la Calle J.L.
        • Perez M.
        • Lopez V.
        Clinical characteristics, patient-reported outcomes, and previous therapeutic management of patients with uncontrolled neuropathic pain referred to pain clinics.
        Pain Res Treat. 2014; 518716: 2014
        • Defrin R.
        • Devor M.
        • Brill S.
        Tactile allodynia in patients with lumbar radicular pain (sciatica).
        Pain. 2014; 155: 2551-2559
        • Enthoven T.M.
        • Scheele J.
        • Bierma-Zeinstra M.A.
        • Bueving J.
        • Bohnen M.
        • Peul C.
        • van W.M.
        • Berger Y.
        • Koes W.
        • Luijsterburg A.J.
        Back complaints in older adults: Prevalence of neuropathic pain and its characteristics.
        Pain Med. 2013; 14: 1664-1672
        • Finnerup N.B.
        • Attal N.
        • Haroutounian S.
        • McNicol E.
        • Baron R.
        • Dworkin R.H.
        • Gilron I.
        • Haanpaa M.
        • Hansson P.
        • Jensen T.S.
        • Kamerman P.R.
        • Lund K.
        • Moore A.
        • Raja S.N.
        • Rice A.S.
        • Rowbotham M.
        • Sena E.
        • Siddall P.
        • Smith B.H.
        • Wallace M.
        Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis.
        Lancet Neurol. 2015; 14: 162-173
        • Finnerup N.B.
        • Haroutounian S.
        • Kamerman P.
        • Baron R.
        • Bennett D.L.
        • Bouhassira D.
        • Cruccu G.
        • Freeman R.
        • Hansson P.
        • Nurmikko T.
        • Raja S.N.
        • Rice A.S.
        • Serra J.
        • Smith B.H.
        • Treede R.D.
        • Jensen T.S.
        Neuropathic pain: An updated grading system for research and clinical practice.
        Pain. 2016; 157: 1599-1606
        • Fishbain A.
        • Cole B.
        • Lewis E.
        • Gao J.
        What is the evidence that neuropathic pain is present in chronic low back pain and soft tissue syndromes? An evidence-based structured review.
        Pain Med. 2014; 15: 4-15
        • Foster N.E.
        • Hill J.C.
        • O’Sullivan P.
        • Hancock M.
        Stratified models of care.
        Best Pract Res Clin Rheumatol. 2013; 27: 649-661
        • Freynhagen R.
        • Baron R.
        • Gockel U.
        • Tolle T.R.
        painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain.
        Curr Med Res Opin. 2006; 22: 1911-1920
        • Freynhagen R.
        • Rolke R.
        • Baron R.
        • Tölle R.
        • Rutjes A.K.
        • Schu S.
        • Treede R.D.
        Pseudoradicular and radicular low-back pain–a disease continuum rather than different entities? Answers from quantitative sensory testing.
        Pain. 2008; 135: 65-74
        • Gerrits M.M.
        • van Oppen P.
        • van Marwijk H.W.
        • Penninx B.W.
        • van der Horst H.E.
        Pain and the onset of depressive and anxiety disorders.
        Pain. 2014; 155: 53-59
        • Gupta M.A.
        • Simpson F.C.
        Obstructive sleep apnea and psychiatric disorders: A systematic review.
        J Clin Sleep Med. 2015; 11: 165-175
        • Hayden J.A.
        • Chou R.
        • Hogg-Johnson S.
        • Bombardier C.
        Systematic reviews of low back pain prognosis had variable methods and results: Guidance for future prognosis reviews.
        J Clin Epidemiol. 2009; 62: 781-796
        • Hayden J.A.
        • van der Windt D.A.
        • Cartwright J.L.
        • Cote P.
        • Bombardier C.
        Assessing bias in studies of prognostic factors.
        Ann Intern Med. 2013; 158: 280-286
        • Hays R.D.
        • Martin S.A.
        • Sesti A.M.
        • Spritzer K.L.
        Psychometric properties of the Medical Outcomes Study Sleep measure.
        Sleep Med. 2005; 6: 41-44
        • Hider S.L.
        • Whitehurst D.G.
        • Thomas E.
        • Foster N.E.
        Pain location matters: The impact of leg pain on health care use, work disability and quality of life in patients with low back pain.
        Eur Spine J. 2015; 24: 444-451
        • Hill J.C.
        • Konstantinou K.
        • Egbewale B.E.
        • Dunn K.M.
        • Lewis M.
        • van der Windt D.
        Clinical outcomes among low back pain consulters with referred leg pain in primary care.
        Spine (Phila Pa 1976). 2011; 36: 2168-2176
        • Hiyama A.
        • Watanabe M.
        • Katoh H.
        • Sato M.
        • Sakai D.
        • Mochida J.
        Evaluation of quality of life and neuropathic pain in patients with low back pain using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire.
        Eur Spine J. 2015; 24: 503-512
        • Hoy D.
        • Brooks P.
        • Woolf A.
        • Blyth F.
        • March L.
        • Bain C.
        • Baker P.
        • Smith E.
        • Buchbinder R.
        Assessing risk of bias in prevalence studies: Modification of an existing tool and evidence of interrater agreement.
        J Clin Epidemiol. 2012; 65: 934-939
        • Hush J.M.
        • Marcuzzi A.
        Prevalence of neuropathic features of back pain in clinical populations: Implications for the diagnostic triage paradigm.
        Pain Manag. 2012; 2: 363-372
        • Koes B.W.
        • van Tulder M.W.
        • Peul W.C.
        Diagnosis and treatment of sciatica.
        BMJ. 2007; 334: 1313-1317
        • Kongsted A.
        • Kent P.
        • Albert H.
        • Jensen T.S.
        • Manniche C.
        Patients with low back pain differ from those who also have leg pain or signs of nerve root involvement - a cross-sectional study.
        BMC Musculoskelet Disord. 2012; 13: 9
        • Konstantinou K.
        • Dunn K.M.
        • Ogollah R.
        • Vogel S.
        • Hay E.M.
        Characteristics of patients with low back and leg pain seeking treatment in primary care: Baseline results from the ATLAS cohort study.
        BMC Musculoskelet Disord. 2015; 16: 332
        • Konstantinou K.
        • Hider L.
        • Jordan L.
        • Lewis M.
        • Dunn M.
        • Hay M.
        The impact of low back-related leg pain on outcomes as compared with low back pain alone: A systematic review of the literature.
        Clin J Pain. 2013; 29: 644-654
        • Mahn F.
        • Hüllemann P.
        • Gockel U.
        • Brosz M.
        • Freynhagen R.
        • Tölle R.
        • Baron R.
        Sensory symptom profiles and co-morbidities in painful radiculopathy.
        PLoS One. 2011; 6: e18018
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement.
        PLoS Med. 2009; 6: e1000097
        • Morsø L.
        • Kent M.
        • Albert B.
        Are self-reported pain characteristics, classified using the PainDETECT questionnaire, predictive of outcome in people with low back pain and associated leg pain?.
        Clin J Pain. 2011; 27: 535-541
      2. National Institute for Health and Care Excellence: Low Back Pain and Sciatica in Over 16s: Assessment and Management. NICE Guideline NG59. Available at: http://nice.org.uk/guidance/ng59 Accessed March 7, 2017

      3. National Institute for Health and Care Excellence: Neuropathic Pain in Adults: Pharmacological Management in Non-Specialist Settings. NICE Guideline CG173. Available at: http://nice.org.uk/guidance/cg173 Accessed March 7, 2017

        • Ouédraogo D.D.
        • Nonguierma V.
        • Napon C.
        • Kabré A.
        • Tiéno H.
        • Guira O.
        • Kaboré J.
        • Drabo Y.
        Prevalence of neuropathic pain among black African patients suffering from common low back pain.
        Rheumatol Int. 2012; 32: 2149-2153
        • Sakai Y.
        • Ito K.
        • Hida T.
        • Ito S.
        • Harada A.
        Neuropathic pain in elderly patients with chronic low back pain and effects of pregabalin: A preliminary study.
        Asian Spine J. 2015; 9: 254-262
        • Schafer A.
        • Hall T.
        • Briffa K.
        Classification of low back-related leg pain–a proposed patho-mechanism-based approach.
        Man Ther. 2009; 14: 222-230
        • Schafer A.
        • Hall T.
        • Muller G.
        • Briffa K.
        Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: A prospective cohort study.
        Eur Spine J. 2011; 20: 482-490
        • Schmidt C.O.
        • Schweikert B.
        • Wenig C.M.
        • Schmidt U.
        • Gockel U.
        • Freynhagen R.
        • Tolle T.R.
        • Baron R.
        • Kohlmann T.
        Modelling the prevalence and cost of back pain with neuropathic components in the general population.
        Eur J Pain. 2009; 13: 1030-1035
        • Smart K.M.
        • Blake C.
        • Staines A.
        • Doody C.
        Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with ‘nociceptive,’ ‘peripheral neuropathic’ and ‘central sensitisation’ pain. The discriminant validity of mechanisms-based classifications of low back (+/-leg) pain.
        Man Ther. 2012; 17: 119-125
        • Smart K.M.
        • Blake C.
        • Staines A.
        • Doody C.
        The discriminative validity of nociceptive, peripheral neuropathic, and central sensitization as mechanisms-based classifications of musculoskeletal pain.
        Clin J Pain. 2011; 27: 655-663
        • Smith B.H.
        • Torrance N.
        Neuropathic Pain.
        in: Croft P.R. Blyth F. Van de Windt D. Chronic Pain Epidemiology. Oxford University Press, Oxford, United Kingdom2010: 209-234
        • Smith B.H.
        • Torrance N.
        • Ferguson J.A.
        • Bennett M.I.
        • Serpell M.G.
        • Dunn K.M.
        Towards a definition of refractory neuropathic pain for epidemiological research. An international Delphi survey of experts.
        BMC Neurol. 2012; 12: 29
        • Torrance N.
        • Smith H.
        • Bennett I.
        • Lee J.
        The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey.
        J Pain. 2006; 7: 281-289
        • Treede R.D.
        • Jensen T.S.
        • Campbell J.N.
        • Cruccu G.
        • Dostrovsky J.O.
        • Griffin J.W.
        • Hansson P.
        • Hughes R.
        • Nurmikko T.
        • Serra J.
        Neuropathic pain: Redefinition and a grading system for clinical and research purposes.
        Neurology. 2008; 70: 1630-1635
        • Tutoglu A.
        • Boyaci A.
        • Karababa I.F.
        • Koca I.
        • Kaya E.
        • Kucuk A.
        • Yetisgin A.
        Psychological defensive profile of sciatica patients with neuropathic pain and its relationship to quality of life.
        Z Rheumatol. 2015; 74: 646-651
        • Uher T.
        • Bob P.
        Neuropathic pain, depressive symptoms, and C-reactive protein in sciatica patients.
        Int J Neurosci. 2013; 123: 204-208
        • Usenbo A.
        • Kramer V.
        • Young T.
        • Musekiwa A.
        Prevalence of arthritis in Africa: A systematic review and meta-analysis.
        PLoS One. 2015; 10: e0133858
      4. VanDenKerkhof EG, Mann EG, Torrance N, Smith BH, Johnson A, Gilron I: An epidemiological study of neuropathic pain symptoms in Canadian adults. Pain Res Manag 2015 Nov 19; [Epub ahead of print]

        • van Hecke O.
        • Austin S.K.
        • Khan R.A.
        • Smith B.H.
        • Torrance N.
        Neuropathic pain in the general population: A systematic review of epidemiological studies.
        Pain. 2014; 155: 654-662
        • Waddell G.
        • Newton M.
        • Henderson I.
        • Somerville D.
        • Main C.J.
        A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.
        Pain. 1993; 52: 157-168
        • Walsh J.
        • Hall T.
        Classification of low back-related leg pain: Do subgroups differ in disability and psychosocial factors?.
        J Man Manip Ther. 2009; 17: 118-123
        • Walsh J.
        • Rabey I.
        • Hall M.
        Agreement and correlation between the self-report leeds assessment of neuropathic symptoms and signs and Douleur Neuropathique 4 Questions neuropathic pain screening tools in subjects with low back-related leg pain.
        J Manipulative Physiol Ther. 2012; 35: 196-202
        • Ware J.E.
        Jr: SF-36 health survey update.
        Spine (Phila Pa 1976). 2000; 25: 3130-3139