Neuropathic component in back pain1-4


While back pain often arises from a nociceptive mechanical cause, both nociceptive and neuropathic mechanisms play a part in most chronic back pain.1-3 It is estimated that around 4% of the general population experience back pain with a neuropathic component1 and a large study2 identified that among severe, chronic back pain patients, some 37% had a likely neuropathic component to their pain, while for another 27.7% the result was unclear.

When assessing the patient with chronic back pain and diagnosing the nature and type of back pain experienced, it is important to keep in mind that there may be a neuropathic component to pain. Neuropathic pain is typically associated with more severe comorbidity than nociceptive pain and is often accompanied by poorer quality of life.3

The presence of a neuropathic component is more frequent with increasing severity of chronic low back pain. In patients with mild pain intensity, neuropathic pain symptoms are clearly diagnosed in 16% of patients, while in patients with severe pain, this percentage increases up to more than 52%.4

 

Back pain often begins with an episode of acute pain  

Back pain often begins with an episode of acute pain that can persist for a period of weeks. Acute back pain is often defined as pain lasting less than 4 weeks. There may then follow a period of sub-acute pain persisting for weeks to months. Back pain that continues for three months is termed chronic back pain.5, 6

Whereas most people experience acute back pain at least once in their lifetime, in 5–10% of cases that pain becomes chronic. The intensity and frequency of back pain is often influenced by psychological components such as stress and dissatisfaction. Women’s back pain tends to last longer than men’s. Men are more likely to have short pain attacks.

 

References
1 Schmidt C et al. Modelling the prevalence and cost of back pain with neuropathic components in the general population. Eur J Pain. 2009; 13:1030-35.
2 Freynhagen R, et al. Curr Med Res Opin. 2006;22:529-37.
3 Freynhagen R, et al. Curr Pain Headache Rep. 2009;13:185-90.
4 Freynhagen R et al. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006; 22(10):1911-20.
5 Frank JW, et al. Spine (Phila Pa 1976). 1996;21:2908-17.
6 National Institute for Health and Clinical Excellence (NICE). NICE clinical guideline 88.Low back pain: Early management of persistent non-specific low back pain. 2009. Available at: http://www.nice.org.uk/nicemedia/live/11887/44343/44343.pdf.