The Neuropathic Components of Chronic Low Back Pain: A Prospective Multicenter Study Using the DN4 Questionnaire
The Neuropathic Components of Chronic Low Back Pain: A Prospective Multicenter Study Using the DN4 Questionnaire
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DOI：
10.1016/j.jpain.2011.05.006
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发表时间：
2011-10-01
期刊：
影响因子：
4
通讯作者：
Bouhassira, Didier
中科院分区：
文献类型：
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作者：
Attal, Nadine;Perrot, Serge;Bouhassira, Didier
本研究采用DN4问卷对有和无下肢疼痛的慢性腰痛（LBP）患者的神经病变成分进行了调查，并证实了其心理测量特性。来自法国11个多学科疼痛或风湿病中心的患者（n = 132）由第一研究者根据魁北克脊柱疾病分类（QTFSD）分为4组：1组（疼痛局限于腰椎区域）；组2（疼痛近端放射）；3组（膝关节以下放射性疼痛，无神经体征）；第4组（疼痛以皮皮分布向足部放射，伴有神经学症状，与典型的神经根病相对应）。第二名研究者将DN4问卷应用于下肢（2至4组）和下背部。第1组和第4组的比较证实了DN4的心理测量特性（敏感性80%；特异性92%，临界值为4/10，类似于其他神经性疾病）。下肢神经性疼痛（NP）患者比例与疼痛放射距离相关（2、3、4组分别为15%、39%、80%，P < 0.0001）。在下背部，典型神经根痛患者出现NP的比例高于其他组（P = 0.006）。因此，典型神经根病与其他神经性疾病具有相似的特征，被确认为LBP患者中最常见的神经性综合征。观察到腰痛的神经性和伤害性成分在背部和下肢不同，可能解释了报道的腰痛NP患病率的差异。由于本研究基本上是基于问卷调查，未来的研究需要结合标准的临床感觉测试、特定的问卷调查和更客观的感觉病变评估来进一步研究慢性腰痛的神经病变成分。观点：本研究证实了DN4问卷评估腰痛患者神经性疼痛的心理测量特性。与背部疼痛相比，下肢疼痛主要是由神经性机制引起的，但神经性疼痛并不局限于典型的神经根病。这可能对这些患者的治疗策略选择具有重要意义。(C) 2011年由美国疼痛学会出版
The present study investigated the neuropathic components of chronic low back pain (LBP) in patients with and without lower limb pain using the DN4 questionnaire and confirmed its psychometric properties. Patients (n = 132) from 11 French multidisciplinary pain or rheumatology centers were classified by a first investigator into 4 groups derived from the Quebec Task Force Classification of Spinal Disorders (QTFSD): group 1 (pain restricted to the lumbar area); group 2 (pain radiating proximally); group 3 (pain radiating below the knee without neurologic signs); and group 4 (pain radiating towards the foot in a dermatomal distribution, with neurological signs, corresponding to typical radiculopathy). A second investigator applied the DN4 questionnaire to the lower limb (groups 2 to 4) and lower back. A comparison of groups 1 and 4 confirmed the psychometric properties of DN4 (sensitivity 80%; specificity 92%, for a cutoff of 4/10, similar to other neuropathic conditions). In the lower limb, the proportion of patients with neuropathic pain (NP) was related to the distality of pain radiation (15, 39, and 80% in groups 2,3 and 4, respectively; P < .0001). In the lower back, the proportion of patients with NP was higher for patients with typical radicular pain compared with the other groups (P = .006). Thus, typical radiculopathy has similar characteristics as other neuropathic conditions and is confirmed as the commonest neuropathic syndrome in LBP patients. The observation that neuropathic and nociceptive components of LBP vary in the back and lower limb probably accounts for the discrepancies of reported prevalence rates of NP in LBP. As this study was essentially based on a questionnaire, future studies combining standard clinical sensory testing, specific questionnaires, and more objective assessment of the sensory lesion are now required to further investigate the neuropathic component of chronic LBP.Perspective: This study confirms the psychometric properties of the DN4 questionnaire to assess neuropathic pain in patients with low back pain. Neuropathic mechanisms largely contribute to pain in the lower limb as compared to the back, but neuropathic pain is not restricted to typical radiculopathy. This may have significant implications for the choice of treatment strategy in these patients. (C) 2011 by the American Pain Society