Neuropathic Pain in Lumbar Disc Herniation: A Comparative Study of Surgical Outcomes

Abstract

Background: This study aimed to assess the prevalence of neuropathic pain in patients diagnosed with lumbar disc herniation and to examine the correlation between neuropathic pain and surgical intervention. Material and methods: We performed a retrospective cohort study involving 217 patients diagnosed with lumbar disc herniation who reported persistent low back pain from January to December 2023. We assessed the existence of neuropathic pain using the Douleur Neuropathique 4 (DN4) questionnaire. We evaluated pain severity using the Visual Analogue Scale (VAS). We categorized the patients into three groups: non-operated, operated without stabilization, and operated with stabilization. Results: The patients had a mean age of 45.09 ± 14.28 years, with 57.6% being male. A DN4 score of > 4 indicated that neuropathic pain was present in more than half (51.2%) of the patients. The prevalence of neuropathic pain was 32.8% in the non-operated cohort, 67.3% in the operated cohort without stabilization, and 85% in the operated cohort with stabilization. Age exhibited a positive link with neuropathic pain score (r = 0.16, p<0.05), whereas no significant association was identified between sex and body mass index (BMI). Conclusion: Individuals with lumbar disc herniation frequently experience neuropathic pain. Surgical intervention, particularly stabilization surgery, is a significant risk factor for the onset of neuropathic pain. Consequently, it is advisable to assess the risk of neuropathic pain and implement appropriate interventions for patients planned for surgical intervention. Age plays a significant role in the development of neuropathic pain, indicating that older patients require closer monitoring.

Keywords

• chronic low back pain
• lumbar disc herniation
• neuropathic pain

Lomber Disk Hernisinde Nöropatik Ağrı: Cerrahi Sonuçların Karşılaştırmalı Bir Çalışması

Öz

Kaynakça

1. 1.Zou T, Liu XY, Wang PC, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-analysis. Clin Spine Surg. 2024;37(6):256-269. https://doi.org/10.1097/BSD.0000000000001490
2. 2.Çalık Y, Çalık AF. Kronik Bel Ağrılı Hastalarda Nöropatik Ağrının Fonksiyonel Yetersizlik Üzerine Etkisinin Değerlendirilmesi. Turk J Osteoporos. 2015;21(3): 122-6. https://doi.org/10.4274/tod.87160
3. 3.Ostafiński K, Świątnicki W, Szymański J, et al. Predicting conservative treatment failure in patients with lumbar disc herniation. Single center, case-control study. Clin Neurol Neurosurg. 2020;193:105867. https://doi.org/10.1016/j.clineuro.2020.105867
4. 4.Shimony N, Louie C, Barrow D, et al. Adolescent Disc Disease: Risk Factors and Treatment Success-Related Factors. World Neurosurg. 2021;148:e314-e320. https://doi.org/10.1016/j.wneu.2020.12.126
5. 5.Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med. 2018;36(4):707-14. https://doi.org/10.1016/j.ajem.2018.01.008
6. 6.Attal N, Perrot S, Fermanian J, Bouhassira D. The neuropathic components of chronic low back pain: a prospective multicenter study using the DN4 Questionnaire. J Pain. 2011;12(10):1080-7. https://doi.org/10.1016/j.jpain.2011.05.006
7. 7.Baron R, Binder A, Attal N, Casale R, Dickenson AH, Treede RD. Neuropathic low back pain in clinical practice. Eur J Pain Lond Engl. 2016;20(6):861-73. https://doi.org/10.1002/ejp.838
8. 8.Yakşi E, Ketenci A, Baslo MB, Orhan EK. Does transcutaneous electrical nerve stimulation affect pain, neuropathic pain, and sympathetic skin responses in the treatment of chronic low back pain? A randomized, placebo-controlled study. Korean J Pain. 2021;34(2):217-28. https://doi.org/10.3344/kjp.2021.34.2.217

9. 9.Mehra M, Hill K, Nicholl D, Schadrack J. The burden of chronic low back pain with and without a neuropathic component: a healthcare resource use and cost analysis. J Med Econ. 2012;15(2):245-52. https://doi.org/10.3111/13696998.2011.642090
10. 10.Freynhagen R, Baron R, Tölle T, et al. Screening of neuropathic pain components in patients with chronic back pain associated with nerve root compression: a prospective observational pilot study (MIPORT). Curr Med Res Opin. 2006;22(3):529-37. https://doi.org/10.1185/030079906X89874
11. 11.Kaki AM, El-Yaski AZ, Youseif E. Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Reg Anesth Pain Med. 2005;30(5):422-8. https://doi.org/10.1016/j.rapm.2005.05.013
12. 12.Sakai Y, Ito K, Hida T, Ito S, Harada A. Neuropathic Pain in Elderly Patients with Chronic Low Back Painand Effects of Pregabalin: A Preliminary Study. Asian Spine J. 2015;9(2):254-62. https://doi.org/10.4184/asj.2015.9.2.254
13. 13.Shiri R, Falah-Hassani K, Heliövaara M, et al. Risk Factors for Low Back Pain: A Population-Based Longitudinal Study. Arthritis Care Res. 2019;71(2):290-9. https://doi.org/10.1002/acr.23710
14. 14.Siddiqui AS, Javed S, Abbasi S, Baig T, Afshan G. Association Between Low Back Pain and Body Mass Index in Pakistani Population: Analysis of the Software Bank Data. Cureus. 14(3):e23645. https://doi.org/10.7759/cureus.23645
15. 15.Ulutaş M, ÇInar K, Seçer M. The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation. Medicine (Baltimore). 2017;96(9):e6238. https://doi.org/10.1097/MD.0000000000006238
16. 16.Akgün AS, Ağirman M. Neuropathic Pain and Disability in Patients with Lumbar Spinal Stenosis. Turk J Geriatr. 2018;21(1):56-61. https://doi.org/10.31086/tjgeri.2018137967
17. 17.Karaci̇f D, Bölükbaşi A. Evaluation of Neuropathic Pain Frequency and Related Factors in Patients with Chronic Low Back Pain. Fiz Tıp Ve Rehabil Bilim Derg. 2022;25(3):332-8. https://doi.org/10.31609/jpmrs.2022-89033
18. 18.Dolgun H, Turkoglu E, Kertmen H, et al. Gabapentin versus pregabalin in relieving early post-surgical neuropathic pain in patients after lumbar disc herniation surgery: a prospective clinical trial. Neurol Res. 2014;36(12):1080-5. https://doi.org/10.1179/1743132814Y.0000000404