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Abstract
BackgroundNeuropathic pain (NP) is common in patients presenting with low back related leg pain. Accurate diagnosis of NP is fundamental to ensure appropriate intervention. In the absence of a clear gold standard, expert opinion provides a useful methodology to progress research and clinical practice. The aim of this study was to achieve expert consensus on a list of clinical indicators to identify NP in low back related leg pain.MethodsA modified Delphi method consisting of three rounds was designed in accordance with the Conducting and Reporting Delphi Studies recommendations. Recruitment involved contacting experts directly and through expressions of interest on social media. Experts were identified using pre-defined eligibility criteria. Priori consensus criteria were defined for each round through descriptive statistics. Following completion of round 3 a list of clinical indicators that achieved consensus were generated.ResultsThirty-eight participants were recruited across 11 countries. Thirty-five participants completed round 1 (92.1%), 32 (84.2%) round 2 and 30 (78.9%) round 3. Round 1 identified consensus (Kendall’s W coefficient of concordance 0.456; p < 0.001) for 10 clinical indicators out of the original 14, and 9 additional indicators were added to round 2 following content analysis of qualitative data. Round 2 identified consensus (Kendall’s W coefficient of concordance 0.749; p < 0.001) for 10 clinical indicators out of 19, and 1 additional indicator was added to round 3. Round 3 identified consensus for 8 indicators (Kendall’s W coefficient of concordance 0.648; p < 0.001). Following completion of the third round, an expert derived consensus list of 8 items was generated. Two indicators; pain variously described a burning, electric shock like and/or shooting into leg and pain in association with other neurological symptoms (e.g. pins and needles, numbness, weakness), were found to have complete agreement amongst expert participants.ConclusionsGood agreement was found for the consensus derived list of 8 clinical indicators to identify NP in low back related leg pain. This list of indicators provide some indication of the criteria upon which clinicians can identify a NP component to low back related leg pain; further research is needed for stronger recommendations to be made.
Highlights
Neuropathic pain (NP) is common in patients presenting with low back related leg pain
Participants Thirty-eight participants were recruited across 11 countries, their experience working with NP in low back related leg pain ranged from 10 to 35 years and they comprised primarily of physiotherapists and researchers/academics
26% had ≥ 2 peer reviewed journals published relating to NP in low back related leg pain
Summary
Neuropathic pain (NP) is common in patients presenting with low back related leg pain. The aim of this study was to achieve expert consensus on a list of clinical indicators to identify NP in low back related leg pain. Neuropathic pain (NP) represents a substantial burden globally, to the individual and the wider economy [1]. Chronic low back pain is the most common type of NP disorder [4], presenting as low back related leg pain; often referred to as sciatica [5]. In comparison to low back pain alone, low back related leg pain is associated with substantially greater pain levels and poorer quality of life [5]. Individuals with low back related leg pain with NP have been found to have a poorer prognosis compared to those with low back related leg pain without NP [5]
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