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.
Highlights
Chronic axial low back pain has a high socioeconomic impact
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
Summary
Chronic axial low back pain has a high socioeconomic impact. With a lifetime prevalence of 30–50% for moderate and severe chronic back pain in an ageing society it depicts a large clinical and economic burden [1,2]. In chronic nociceptive pain intact nociceptors are activated by tissue damaging stimuli (i.e. ATP, prostaglandins, protons, etc.). This is caused by inflammatory processes in affected muscles, tendons, intervertebral discs and facet joints [8]. The question arises whether mixed pathophysiological mechanisms contribute to axial back pain. This entity has long been considered as purely nociceptive but clinical and diagnostic findings suggest a neuropathic influence [12]. The heterogeneity of different underlying pain mechanisms reveal a much more complex framework than previously assumed and it might explain why pharmacological treatment is often disappointing
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