Neuropathic Pain Component In Patients Research Articles

Pain type and neuropathic pain components in acute herpes zoster.

The aim of this study was to investigate the pain type (nociceptive or neuropathic) and neuropathic pain components in patients with acute herpes zoster (HZ). Patients with acute HZ referred to the outpatient Dermatology and Venereology clinic between January 2021 and January 2022 were retrospectively detected. The demographic data including gender and age, rash localization, pain severity, and neuropathic pain components were recorded. Pain severity and neuropathic pain components were evaluated using a Visual Analog Scale (VAS) and Douleur Neuropathique 4 (DN4), respectively. The study included a total of 58 patients, comprising 33 females and 25 males. Of these patients, 35 (60.3%) were found to have neuropathic pain. Itching, burning, pins and needles, and tingling were the most frequently reported neuropathic pain signs and symptoms. The proportion of female patients with neuropathic pain was found to be significantly higher than that of male patients (p=0.021). No significant differences were observed in the distribution of pain across different body sites or in the age of patients with neuropathic pain (p>0.05). Itching was significantly more common in younger patients (p=0.02). In conclusion, the study found that over half of the patients with acute HZ experienced neuropathic pain, and this was more frequently observed in female patients. Analysis of different components of neuropathic pain showed significant differences in age, gender, and site distribution. The findings of this study may have important implications for the manage-ment and treatment of acute HZ.

Presence of a neuropathic pain component in patients with chronic pain after gunshot wounds

In patients with gunshot wounds, chronic pain is observed in 70% of cases. One of the factors that influence such a high frequency of pain chronicity is the number of localizations of injured anatomical parts of the body – in patients with injuries in 1 or 2 anatomical parts of the body, the frequency of chronicity is 69.7%, and in patients with injuries in 3 – 71.2% of cases. Also, the presence of a neuropathic component of pain in this category of patients and its possible impact on such a high frequency of chronicity remains unexplored.
 Materials. The treatment of 769 patients was analyzed. The Douleur Neuropathique 4 questions were used to identify neuropathic pain. The Shapiro-Wilk, Mann-Whitney, Friedman's Bonferroni correction, and chi-square test with a continuity correction were also used. In all cases, the critical level of significance was set at 0.05.
 Results. Douleur Neuropathique 4 questions data indicate that all patients had a neuropathic pain component (scores range from 4 to 5). At the time of discharge at the stage of treatment in military medical clinical centers, we observed the absence of a neuropathic component of pain in some patients – these were those patients who did not have chronic pain. After 1 month – p=0.918, 3 months – 0.713, 6 months – p=0.824, and 12 months – p=0.911 observation, the data did not differentiate.
 Conclusions. Patients who received gunshot wounds have a high risk of chronic pain. It was found that the neuropathic component of pain is present in all patients of this category, so it may be one of the key components of such a high frequency of chronicity.

Neuropathic pain component and its association with time elapsed since pain onset in patients with low back pain.

Time elapsed since pain onset might affect the likelihood of neuropathic component in low back pain. The aim of this study was to investigate the relationship between neuropathic pain component and pain duration in patients with low back pain and to identify factors associated with neuropathic pain component. Patients with low back pain who received treatment at our clinic were enrolled. Neuropathic component was assessed using the painDETECT questionnaire at the initial visit. PainDETECT scores and the results for each item were compared according to pain duration category (< 3months, 3months to 1year, 1year to 3 years, 3 years to 10 years, and ≥ 10 years). A multivariate analysis was used to identify factors associated with neuropathic pain component (painDETECT score ≥ 13) in low back pain. A total of 1957 patients, including 255 patients who reported neuropathic-like pain symptoms (13.0%), fully satisfied the study criteria for analysis. No significant correlation between painDETECT score and pain duration was observed (ρ=-0.025, p=0.272), and there were no significant differences between median painDETECT score or trend of change in the proportion of patients with neuropathic component and the pain duration category (p=0.307, p=0.427, respectively). The electric shock-like pain symptom was frequently reported in patients with acute low back pain, and the persistent pain pattern with slight fluctuations was predominant in chronic low back pain. The pattern of attacks with pain between them was much less common in patients with pain for 10 years or longer. Multivariate analysis revealed that a history of lumbar surgery, severe maximum pain, opioid use, lumbosacral radiculopathy, and sleep disturbance were significantly associated with a neuropathic component in low back pain. Time elapsed since current pain onset did not correlate with neuropathic pain component in patients with low back pain. Therefore, diagnostic and therapeutic approaches for this condition should be based on a multidimensional evaluation at assessment and not on pain duration alone.

Neuropathic Pain Component in Patients with Cervical Radicular Pain: A Single-Center Retrospective Study.

Background and Objectives: Evidence regarding the prevalence of neuropathic pain in patients with cervical radicular pain is limited. This study aimed to investigate the prevalence of neuropathic pain components in patients with cervical radicular pain using established screening tools and identify the relationship between neuropathic pain components and clinical factors. Materials and Methods: Data from 103 patients (aged ≥ 20 years) with cervical radicular pain who visited our pain clinic were analyzed retrospectively. Demographic characteristics, history of neck surgery, pain intensity using numeric rating score, dominant pain site, duration of symptoms, and neck disability index were assessed. The prevalence of neuropathic pain components was defined according to the Douleur Neuropathique 4 questions and painDETECT questionnaire tools. Patient characteristics were compared using the chi-square test or Fisher’s exact test for categorical variables and the independent t-test or Mann–Whitney U test for continuous variables. The correlation between neck disability index and other variables was analyzed using Pearson’s correlation coefficient. Results: Of the 103 patients, 29 (28.1%) had neuropathic pain components. The neck disability index was significantly higher (p < 0.001) for patients in the neuropathic pain group (23.79 ± 6.35) than that in the non- neuropathic pain group (18.43 ± 7.68). The Douleur Neuropathique 4 questions (r = 0.221, p < 0.025) and painDETECT questionnaire (r = 0.368, p < 0.001) scores positively correlated with the neck disability index score. Conclusions: The prevalence of neuropathic pain components in patients with cervical radicular pain was low. The patients in our study showed a strong correlation between functional deterioration and their neuropathic pain screening score. This study may be useful in understanding the characteristics of cervical radicular pain.

Frequency of neuropathic pain in patients with shoulder pain.

Shoulder pain is one of the most common musculoskeletal disorders in general population. Although shoulder pain is completely resolved within one year after treatment in more patients, persistent pain is observed in remaining patients. Neuropathic pain may play a role in persistent shoulder pain in some patients. The aim of the study was to investigate the neuropathic pain component in patients with shoulder pain. 49 patients with shoulder pain were enrolled in this study. The Pain-Detect questionnaire was used to determine the presence of neuropathic pain. Visual analogue scale (VAS) was used to evaluate shoulder pain. Quick Disabilities of the Arm, Shoulder and Hand (Quick-Dash) was used to determine to measure physical function and symptoms. The neuropathic pain component in patients with shoulder pain was 20% and possible neuropathic pain was 19% according to Pain-Detect questionnaire. The mean VAS score, Quick-Dash score and symptom duration were significantly higher in the neuropathic pain group. The patients with shoulder pain have a neuropathic pain component. We suggest that neuropathic pain should be assessed when prescribing treatment programs in patients with shoulder pain.

Nearly half of patients with chronic tendinopathy may have a neuropathic pain component, with significant differences seen between different tendon sites: a prospective cohort of more than 300 patients

ObjectivesIdentifying the prevalence of neuropathic pain components in patients with chronic tendinopathy conditions using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire.MethodsPatients with chronic tendinopathy and ‘tendon-like’...

Evaluation of Neuropathic Pain Component in Myofascial Pain Syndrome; Its Effect on Emosyonel State, Sleep and Quality of Life

Objective: The aim of this study was to evaluate the neuropathic pain component in patients with myofascial pain syndrome, and to examine the effects of neuropathic pain on emotional status, sleep and quality of life.&#x0D; Material and Methods: 73 patients with MPS in their neck or upper back region admitted to the tertiary university hospital were included. Questionnaires were administrated to the patients via face-to-face interviews, and included sociodemographic variables. The patients were evaluated for neuropathic component by DN4 questionnaires, and pain by visual analog scale (VAS). Validated questionnaires measuring emosyonel status, sleep quality and quality of life were used.&#x0D; Results: Of the 73 patients, 48 (65.8%) were female and 25 (34.2%) were male. The mean age of all recruited patients was 38.2±10.6 years. According to the DN4 scale 56.2% of the patients had neuropathic pain. MPS patients were divided into two groups as those with and without neuropathic pain. VAS, BDI, and PSQI scores were significantly higher among MPS patients with neuropathic pain than among MPS patients without neuropathic pain (p&lt;0.01).The patients with neuropathic pain had lower scores for all the parameters of the SF-36. Morever vitality, social function, mental health, and emotional role dimensions scores were significantly lower in MPS patients with neuropathic pain than MPS patients without neuropathic pain (p&lt;0.01).&#x0D; Conclusion: An appropriate diagnosis and treatment of the neuropathic pain plays an important role and can reduce the pain, improve the quality of life and sleep qulity, and decrease the level of depression in treatment of MPS.

Нейропатический компонент боли у больных остеоартритом

Background: chronic joint pain in osteoarthritis (OA) is an important factor of maladaptation. According to modern concepts, there are two variants presented in this pathology: nociceptive and nociplastic. Much less is known about the contribution of the neuropathic component (NC) to the pain syndrome formation. Aim: to study the pain syndrome patterns in patients with OA, as well as to identify NC in such patients and its impact on the life quality. Patients and Methods: the prospective study included 31 patients (mean age — 62.9±6.7 years, 26 (83.9%) women) with stage I–III OA of the knee and/or hip joint. The course of the articular syndrome corresponded to the pain syndrome course and ranged from 2 months to 30 years, averaging 10.6±9.9 years. All patients underwent general clinical examination. To detect neuropathic pain component (NPC), a neurological examination was performed using the DN4 and painDETECT questionnaires. The level of life quality was determined by the EQ-5D questionnaire. Results: NPC was detected in almost half (48%) of the examined patients. At the same time, the severity of radiological changes in the joints did not depend on its presence. However, in the presence of NC, the following manifestations were significantly more common in the area of the most affected joint (p&lt;0.05): burning, numbness, electric shock, hypoesthesia, tingling, a feeling of crawling and/or tingling. There was practically no such symptom as itching, while the frequency of hypoesthesia in the groups did not significantly differ. According to the EQ-5D questionnaire, lower indicators were observed in patients with the NPC, their mobility assessment and daily activity were significantly worse. Mixed anxiety–depressive disorder were also observed (p&lt;0.05) in such patients. Conclusion: for adequate treatment of pain syndrome, it is necessary to determine the presence of NPC in patients with OA and use antidepressants and anticonvulsants in complex therapy. KEYWORDS: osteoarthritis, chronic pain syndrome, nociceptive pain, nociplastic pain, neuropathic pain component, life quality. FOR CITATION: Filimonova O.G. Neuropathic pain component in patients with osteoarthritis. Russian Medical Inquiry. 2022;6(3):113–119 (in Russ.). DOI: 10.32364/2587-6821-2022-6-3-113-119.

Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study.

BackgroundLow back pain (LBP) is caused by disc herniation, spinal stenosis, facet syndrome or etc. This LBP could be either nociceptive or neuropathic pain (NP). In addition, these neuropathic pain is a major contributor to chronic low back pain. It is already known that lumbar epidural steroid injection (ESI) is effective for low back pain, but no study has assessed both nociceptive and neuropathic pain separately. This study investigated whether neuropathic or nociceptive pain was better improved after an epidural steroid injection.MethodsThis was a prospective study. Patients were classified according to the pre-procedure painDETECT questionnaire (PD-Q) score. If the PD-Q score was ≤12, it was considered as nociceptive pain, and it the PD-Q was ≥19, it was considered NP. The patients were given a transforaminal (TF) or interlaminar (IL) epidural steroid injection (ESI). The PD-Q was filled out by each patient prior to the ESI (baseline), and again at 4 weeks after the ESI. Outcomes was assessed using a numerical rating scale (NRS) score, short form McGill Pain Questionnaire (MPQ), and revised Oswestry Back Disability Index (ODI) at 1 month later.ResultsA total of 114 patients were enrolled and of these, 54 patients with a PD-Q score of ≤12 were classified into the nociceptive pain, and 60 patients with a PD-Q score ≥19 were classified into the neuropathic pain group. At 1 month after treatment, both groups had significantly lower than improved their mean NRS score. Not withstanding these improvements and difference between NRS, the differences in MPQ and ODI after treatment between the groups (nociceptive vs. neuropathic) not significant. After the procedure (TF-ESI or IL-ESI), the patients in group 1 (PD-Q score ≤12, n = 54) had no change in their PD-Q score. Among the patients in group 2 (pre-treatment PD-Q score ≥19, n = 41), 13 patients moved to a PD-Q score <12 and 15 patients had a PD-Q score of 13–18.ConclusionFor the short-term relief of neuropathic pain, ESI was effective for both nociceptive and neuropathic pain, therefore ESI could be treat the try neuropathic pain component in patients with low back pain.

Effectiveness of Pregabalin Treatment for Neuropathic Pain in Patients with Spine Diseases: A Pooled Analysis of Two Multicenter Observational Studies in Japan.

PurposeNeuropathic pain (NeP) is common among patients with chronic pain associated with spine diseases. Practical effectiveness of pregabalin, one of the first-line treatments for NeP, has not been evaluated in an entire population of patients with spine diseases, including various pathophysiological conditions. This pooled analysis aimed to evaluate the therapeutic value of pregabalin for chronic pain with NeP component in patients with spine diseases in routine primary care settings.Patients and MethodsWe pooled data from two 8-week prospective observational cohort studies for patients with chronic low back pain with accompanying lower limb pain (NeP component), and patients with chronic cervical pain and accompanying upper limb radiating pain (NeP component) in routine primary care settings in Japan. For both studies, patients were treated for 8 weeks with pregabalin (alone/with other analgesics) or usual care with conventional analgesics (eg, non-steroidal anti-inflammatory drugs). Changes in pain numerical rating scale (NRS), Pain-Related Sleep Interference Scale (PRSIS), and EuroQol 5-dimension 5-level (EQ-5D-5L) scores from baseline to week 8 were summarized and compared between the pregabalin and usual care groups, and also for subgroups of primary diagnosis. Safety was evaluated by adverse events (AEs) in the pregabalin group.ResultsThe pooled dataset comprised 700 patients (pregabalin group: 302; usual care group: 398). All patient-reported outcomes (PRO) scores significantly improved from baseline to week 8 in the pregabalin than in the usual care group (NRS: P<0.0001; PRSIS: P<0.0001, and EQ-5D-5L: P=0.0006). Overall, all three PRO measures showed greater improvement in the pregabalin than in the usual care group, irrespective of the primary diagnosis. AEs were reported in 36.1% of the pregabalin group.ConclusionThis analysis suggested multi-faceted effectiveness of treatment with pregabalin from the patient’s perspectives under a “real-world” practice in all patients with chronic NeP from various spine diseases.

Transforaminal Epidural Steroid Injection Improves Neuropathic Pain in Lumbar Radiculopathy: A Prospective, Clinical Study.

This study aims to evaluate the effects of transforaminal epidural steroid injection (TFESI) on neuropathic pain (NP) in patients with chronic unilateral radiculopathy due to lumbar disc herniation (LDH). Between September 2018 and April 2019, a total of 61 patients who were diagnosed with unilateral/unilevel radiculopathy due to LDH and were scheduled for single-level TFESI were included in this study. The Numeric Rating Scale (NRS), modified Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and NP-Douleur Neuropathique 4 Questionnaire (DN4) were used before the procedure and at 1 hour, 3 weeks, and 3 months after the procedure. There was a significant decrease in the NRS and significant improvement in the ODI, BDI, and DN4 scores in all patients at all postprocedural timepoints (P < 0.05). The number of patients with NP decreased from 35 (60.3%) at baseline to 23 (41.2%) at 3 months (P = 0.001). The NRS scores were similar at 3 weeks and 3 months between the patients with and without NP (P > 0.05). The ODI scores were significantly higher at 3 months in the patients with NP than those without NP (P = 0.013). The BDI scores at baseline, 3 weeks, and 3 months were significantly higher in the patients with NP than those without NP (P < 0.001, P = 0.016, and P = 0.016, respectively). Our study results suggest that TFESI is an effective and safe method to decrease not only nociceptive but also NP component in patients with chronic radiculopathy due to LDH. Clinicians should keep in mind that NP is a risk factor that adversely affects the TFESI success and patients should be evaluated before the procedure.

Somatosensory dysfunction related neuropathic pain component affects disease activity, functional status and quality of life in ankylosing spondylitis.

To investigate the neuropathic pain (NP) component in ankylosing spondylitis (AS) and to assess the relations between NP and disease characteristics. Eighty participants were included in this study. Demographic properties, duration of disease, laboratory values and clinical assessments (visual analog scale [VAS], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], Bath Ankylosing Spondylitis Metrology Index [BASMI], Short Form [SF]-36 questionnaire, Beck Depression Inventory [BDI]) were recorded. The NP component was assessed by both DN4 and PainDETECT questionnaires (PD-Q) and patients were classified into groups according to questionnaire scores. NP component was detected by the DN4 and PD-Q in 40% and 28.7% of our patients, respectively. Likely-NP group had significantly higher scores in VAS-pain, BASDAI, BASFI, BASMI and BDI compared with both uncertain-NP and unlikely-NP groups. There was no significant difference between the SF-36 scores of the likely-NP and uncertain-NP groups. Moreover, all SF-36 scores were significantly lower in the likely-NP group than in the unlikely-NP group. Based on DN4 scale, patients with NP had significantly higher erythrocyte sedimentation rate (ESR), VAS, BASDAI, BASFI, BASMI scores and significantly lower SF-36 (except social functioning) scores compared to patients without NP. Both painDETECT and DN4 scores of the patients were significantly positively correlated with ESR, VAS, BASDAI, BASFI, BASMI, BDI scores and negatively correlated with all SF-36 scores. Our results revealed that the presence of NP component in patients with AS is associated with various disease-related variables, including pain, high disease activity, reduced mobility of the axial skeleton, depression and poor quality of life.

Neuropathic pain component in patients with myotonic dystrophy type 2 – a pilot study

Neuropathic pain component in patients with myotonic dystrophy type 2 – a pilot study

Diagnostic accuracy of upper limb neurodynamic tests for the assessment of peripheral neuropathic pain: A systematic review

BackgroundUpper limb neurodynamic tests (ULNTs) are used to identify a neuropathic pain component in patients' presenting with arm and/or neck pain. Clinical tests with established diagnostic accuracy are required to not only to inform clinical management but also minimise costs associated with expensive medical investigations. ObjectiveTo evaluate the role of ULNTs in assessment of peripheral neuropathic pain and to inform their value in clinical practice when assessing patients with arm and/or neck symptoms. DesignSystematic review was undertaken according to published guidelines, and reported in line with PRISMA-DTA. MethodKey databases were searched up to 21/11/2017. Inclusion criteria: Patient population experiencing arm and/or neck symptoms with suspected peripheral neuropathic involvement, studies that compared ULNT to a reference standard, any study design using primary diagnostic accuracy data. Two reviewers independently assessed risk of bias (ROB) using QUADAS-2. The overall quality of evidence was evaluated using GRADE. ResultsOf eight included studies (n = 579), four were assessed as low ROB, although all had concerns regarding applicability. For carpal tunnel syndrome, ULNT1 sensitivity values ranged 0.4–0.93, specificity 0.13–0.93, positive likelihood ratio 0.86–3.67 and negative likelihood ratio 0.5–1.9. For cervical radiculopathy ULNT1 and the combined use of four ULNTs had sensitivity of 0.97 (95%CI 0.85–1.00) whereas the ULNT3 was the most specific (0.87, 95%CI 0.62–0.98). Positive likelihood ratio ranged 0.58–5.68 and negative likelihood ratio 0.12–1.62. ConclusionBased on the available evidence ULNTs cannot be utilised as a stand-alone test for the diagnosis of CTS. Limited evidence suggests that ULNTs may be clinically relevant for the diagnosis of CR, but only as a “ruling out” strategy. However, the overall quality of the body of evidence after applying the GRADE approach was low to very low across studies. Further higher quality research is needed to establish firm conclusions.

Neuropathic Pain Component in Axial Spondyloarthritis and the Influence on Disease Burden

Patients with nonradiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA/ankylosing spondylitis (AS) have similar burden of disease; however, the potential influence of pain characteristics including the neuropathic pain (NeP) component has not been assessed yet. The aim of this study was first to assess frequency of NeP component in patients with axSpA and second to assess the potential influence of NeP on burden of disease. Adult patients who met the Assessment of SpondyloArthritis International Society classification criteria for axSpA were consecutively recruited. Patients were evaluated using the Douleur Neuropathique en 4 Questions interview and painDETECT questionnaire and subgrouped as patients with and without NeP. Neuropathic pain component was present in 31.4% of patients with axSpA categorized according to Douleur Neuropathique en 4 Questions (31.6% in nr-axSpA vs 31.3% in AS, P = 0.964) and in 33.5% of patients categorized according to painDETECT (35.1% in nr-axSpA vs 32.8% in AS, P = 0.762). Pain characteristics were quite similar between patients with nr-axSpA and AS. Women tented to have more frequent NeP. Patients with NeP component had significantly higher scores in visual analog scale of pain, patient and physician global, fatigue, Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score using C-reactive protein, depression, anxiety scores, and physical functions; poorer quality of life (QoL); and similar frequency of fibromyalgia compared with patients without NeP component. In multivariable analysis, having NeP was associated with QoL measures (Ankylosing Spondylitis Quality of Life and Short-Form 36 physical component score) and visual analog scale of fatigue. Nearly one third of patients with axSpA may have NeP component regardless of having nr-axSpA or AS. Neuropathic pain component may contribute worsened QoL and poorer patient-reported outcome data and should be kept in mind during patient evaluation.

Testing the validity and reliability of the Arabic version of the painDETECT questionnaire in the assessment of neuropathic pain

IntroductionNeuropathic pain (NP) can cause substantial suffering and, therefore, it must be diagnosed and treated promptly. Diagnosis of NP can be difficult and if made by an expert pain physician is considered the gold standard, however where expert help may not be easily available, screening tools for NP can be used. The painDETECT questionnaire (PD-Q) is a simple screening tool and has been widely used in several languages. We developed an Arabic version of PD-Q and tested its validity and reliability.MethodsThe original PD-Q was translated into the Arabic language by a team of experts. The translated version of the PD-Q was administered to the study population, which included patients having moderate to severe pain for at least three months. Reliability of the Arabic version was evaluated by an intra-class-correlation coefficient (ICC) between pre- and post-measures and Cronbach’s α values. Validity was measured by receiver operating characteristic (ROC) curve. Expert pain physician diagnosis was considered as the gold standard for comparing the diagnostic accuracy.ResultsA total of 375 patients were included in the study, of which 153 (40.8%) patients were diagnosed with NP and 222 [59.2%] patients had nociceptive pain. The ICC between pre- and post-PD-Q scale total scores for the overall sample, NP group, and NocP group was 0.970 (95% CI, 0.964–0.976), 0.963 (95% CI, 0.949–0.973), and 0.962 (95% CI, 0.951–0.971), respectively. The Cronbach’s α values for the post-assessment measures in the overall sample, NP group, and nociceptive pain group, were 0.764, 0.684, and 0.746, respectively. The area under the ROC curve was 0.775 (95% CI, 0.725–0.825) for the PD-Q total score.ConclusionThe Arabic version of the PD-Q showed good reliability and validity in the detection of NP component in patients with chronic pain.

Usefulness of four commonly used neuropathic pain screening questionnaires in patients with chronic low back pain: a cross-sectional study.

BackgroundRecently symptoms-based screening questionnaires have gained attention for screening for a neuropathic pain component (NePC) in various chronic pain conditions. The present study assessed the usefulness of four commonly used NePC screening questionnaires including the Self-completed douleur neuropathique 4 (S-DN4), the ID Pain, the painDETECT questionnaire (PDQ), and the Self-completed Leeds Assessment of neuropathic Symptoms and Signs (S-LANSS) questionnaire in patients with chronic low back pain (CLBP) to assess the presence of NePC.MethodsThis is a single-center cross-sectional study where patients with CLBP, with or without leg pain, were included. Participants were initially screened for NePC presence by a physician according to the regular practice, and later assessed using screening questionnaires. The diagnostic accuracy of these questionnaires was compared assuming the physician-made diagnosis as the gold standard.ResultsA total of 215 patients with CLBP of which 164 (76.3%, 95% CI, 70.2-81.5) had a NePC were included. S-DN4, ID Pain, and PDQ have an area under the curve (AUC) > 0.8 indicating excellent discrimination. However, S-LANSS has an AUC of 0.69 (0.62-0.75), indicating low discrimination. S-DN4 has a significantly higher AUC as compared to ID Pain (d(AUC) = 0.063, P < 0.01) and S-LANSS (d(AUC) = 0.197, P < 0.01). But the AUC of S-DN4 does not significantly differ from that of PDQ (d(AUC) = 0.013, P = 0.62).ConclusionsS-DN4, ID Pain, and PDQ, but not S-LANSS, have good discriminant validity to screen for NePCs in patients with CLBP. Despite using all the tests, 20-30% of patients with an NePC were missed. Thus, these questionnaires can only be used as an initial clue in screening for NePCs, but do not replace clinical judgment.

Pain Syndrome, Markers of Bone Metabolism in Patients with Osteoarthritis, Approaches to Drug Therapy and the Impact of Obesity

The objective: to assess the nature of pain in patients with osteoarthritis, the impact of obesity on the clinical efficacy of treatment of osteoarthritis (OA) and dynamics of bone metabolism markers. Patients and methods. The research included 150 patients with OA, who were divided into two groups, according to the receiving therapy. Patients of the main group – received diacerein (drug «Flexirin» PC «Kyiv Vitamin Factory») and patients of control group – received only nonsteroidal anti-inflammatory drugs (NSAIDs). Results. The prevalence of neuropathic pain component in patients with OA was 64,7%, among which 80,7% use NSAIDs as an analgesic therapy. Obesity in patients with OA was associated with significantly higher levels of pain from the side of knee joints and higher degree of stiffness according to WOMAC index. The results of the study demonstrated a direct moderate correlation (R = 0,49; p = 0,04) between PICP level and the severity of pain at physical load from the side of hands and hip joints. The therapy by diacerein within 3 months resulted in a reliable decrease of pain syndrome intensity from the side of all articular zones, unlike to isolated NSAIDs use, where a reliable analgesic effect was demonstrated only from the side of knee joints. Obesity in patients with OA led to a significant decrease in clinical efficacy of therapy in point of functional status of the joints. Conclusions. Neuropathic pain is quite common among patients with OA, which at the same time is associated with the lack of patient’s awareness about possible risks during NSAID’s use. Medical treatment by diacerein (drug “Flexirin”) causes stability of osteocalcin level, in contrast to the isolated NSAIDs use, where priority changes have been demonstrated against osteocalcin level decrease. The use of diacerein also resulted to additional positive effects from the side of zonal prevalence of analgesic effect and improving of functional ability of joints. Obesity in patients with OA was associated with a reliable increase of pain level intensity from the side of knee joints and the higher degree of functional limitation, causing at the same time, reduction of clinical efficacy of therapy in point of achieving analgesic effect and improving functional ability of joints.

The use of electroneurography for differentiation of neuropathic pain component in patients with chronic pain syndromes of the lumbar-sacral localization

Aim of research: to study the possibility to use the separate methods of electroneurography, namely nociceptive flexor reflex (NFR) for determination of neuropathic component of pain in patients with the chronic pain syndrome of lumbar-sacral localization.Materials and methods: 103 patients with the chronic vertebrogenic lumbar-sacral pain syndrome (CVLSPS) and 30 practically healthy persons were examined. According to the results of clinical-neurological examination all patients were divided in groups that corresponded to the first four groups of Classification of spine disease of Quebec special commission (CSDQSC). The determination of state of peripheral neuromotor apparatus was realized using electroneurography of the calf nerve, after that the NFR study was realized.Results: the speeds of impulse passing on the calf nerve did not differ between patients with CVLSPS and the control group. The reliable decrease of pain threshold (PT) (7,65±1,77), reflex threshold (RT) (9,67±2,0) and ratio of pain threshold/reflex threshold (PT/RT) (0,77±0,11) were revealed in the group of patients with CVLSPS comparing with the group of practically healthy examined persons (8,90±0,94, 10,38±1,05 and 0,86±0,07 respectively). At the analysis of NFR parameters between the groups of patients with CVLSPS the statistically significant differences in PT and RT parameters were not found. PT/RT ratio was statistically reliably lower in IV group (0,73±0,12) comparing with other three groups of patients.Conclusions: patients with CVLSPS have the reliably lower values of PT and RT and PT/RT ratio comparing with practically healthy persons. PT/RT ratio is the most specific parameter of NFR for differentiation of nociceptive and neuropathic pain components

P03 -Identification of neuropathic pain component in patients of various age with knee osteoarthritis

P03 -Identification of neuropathic pain component in patients of various age with knee osteoarthritis