Neuropathic Pain Prevalence in Patients Presenting with Musculoskeletal Pain

Öz

Pain is one of the most common symptoms of illness in an individual's life. For physical therapy and rehabilitation doctors, musculoskeletal pain is one of the most common problems they encounter in their professional life. Neuropathic pain is one of the subtypes of pain. It is a complex condition that occurs with the influence of the somatosensory system and presents with symptoms such as numbness, tingling, and burning contrary to classical pain. The aim of this study is to investigate the frequency of neuropathic pain and associated factors in patients presenting with musculoskeletal pain. Patients who applied to the outpatient clinic with musculoskeletal pain were included in the study. Self-Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and visual analog scale (VAS) were used to evaluate the pain status of the patients. 181 patients who met the exclusion and participation criteria were included in the study. It was found that 29,3% of the patients with musculoskeletal pain accompanied neuropathic pain. While the frequency of neuropathic pain was found to be statistically significantly higher with increasing age, no significant relationship was found between other variables and neuropathic pain development. In conclusion, the frequency of neuropathic pain was found to be high in patients who applied to the outpatient clinic with musculoskeletal pain. The results suggest that the neuropathic component should also be taken into account in the diagnosis and treatment of patients with musculoskeletal pain due to the frequency of the coexistence of these two conditions.

Anahtar Kelimeler

• Neuropathic pain
• Burning pain
• Musculoskeletal system

Kas İskelet Sistemi Ağrısı ile Başvuran Hastalarda Nöropatik Ağrı Sıklığı

Öz

Ağrı, bireyin hayatında en çok karşılaştığı hastalık semptomlarındandır. Fizik tedavi ve rehabilitasyon doktorları için de kas iskelet sistemi ağrıları meslek hayatında en sık karşılaştıkları problemlerdendir. Nöropatik ağrı, ağrının alt tiplerinden birisidir. Somatosensoriyel sistemin etkilenmesiyle meydana gelen ve klasik ağrının aksine uyuşma, karıncalanma, yanma gibi bulgularla seyreden kompleks bir durumdur. Bu çalışmada amaç, kas iskelet sistemi ağrısıyla başvuran hastalarda nöropatik ağrı sıklığını ve ilişkili olabilecek faktörleri araştırmaktır. Polikliniğe kas iskelet sistemi ağrısıyla başvuran hastalar çalışmaya dahil edildi. Hastaların ağrı durumunun değerlendirilmesi için Nöropatik Semptom ve İşaretlerin Kendi Kendine Değerlendirilmesi (S-LANSS) skalası ve görsel analog skala (VAS) uygulandı. Çalışmaya dışlama ve katılma kriterlerine uyan 181 hasta alındı. Kas iskelet sistemi ağrısı olan hastaların %29,3’ünde nöropatik ağrının eşlik ettiği tespit edildi. Yaşın artmasıyla nöropatik ağrı sıklığı istatistiksel olarak anlamlı şekilde yüksek bulunurken, diğer değişkenlerle nöropatik ağrı oluşumu arasında anlamlı ilişki saptanmadı. Sonuç olarak, kas iskelet sistemi ağrısı ile polikliniğe başvuran hastalarda nöropatik ağrı sıklığı yüksek bulunmuştur. Sonuçlar bu iki durumun birlikteliğinin sıklığı nedeniyle kas iskelet sistemi ağrılı hastaların tanı ve tedavisinde nöropatik komponentinin de dikkate alınması gerektiğini düşündürmektedir.

Anahtar Kelimeler

• Nöropatik ağrı
• Yanıcı ağrı
• Kas iskelet sistemi

Kaynakça

1. 1. Swieboda P, Filip R, Prystupa A, Drozd M. Assesment of pain: types,mechanism and treatment. Ann Agric Environ Med. 2013;1:2-7.
2. 2. Nijs J, Apeldoorn A, Hallegraeff H, et al. Low back pain: guidelines for the clinical classification of predominant neuro-pathic, nociceptive, or central sensitization pain. Pain Physi-cian. May-Jun 2015;18(3):333-46.
3. 3. IASP. IASP terminology. https://www.iasp-pain.org/terminology?.2019.
4. 4. Jensen TS, Baron R, Haanpää M, et al. A new definition of neuropathic pain. Pain 2011;152(10):2204-5.
5. 5. Vadalouca A, Siafaka I, Argyra E, Vrachnou E, Moka E. The-rapeutic management of chronic neuropathic pain: an examina-tion of pharmacologic treatment. Ann N Y Acad Sci 2006;1088:164-86.
6. 6. French HP, Smart KM, Doyle F. Prevalance of neuropathic pain in knee or hip osteoarthritis: A systematic review and me-ta-analysis. Semin. Arthritis Rheum. 2017 Aug;47(1):1-8.
7. 7. Colombo B, Annovazzi PO, Comi G. Medications for neuro-pathic pain: current trends. Neurol Sci. 2006;27(Suppl 2):S183–9.
8. 8. Galvez R, Rejas J, Perez M, Gomez M. Prevalence of neuro-pathic pain in Spain: clinical, working and health care implica-tions. Med Clin (Barc). 2005; 125(6):221–9.

9. 9. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 2001;92:147-57.
10. 10. Bennett M. Using screening tools to identify neuropathic pain. Pain 2007;127:199-203.
11. 11. Yücel A. Resuls of Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study. The Journal of Pain 2004;5:427-32.
12. 12. Validity and Reliability of the Turkish Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) Questionnaire. Pain Medicine 2010;11:1107–14.
13. 13. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983;16:87–101
14. 14. Torrance N. The Epidemiology of Chronic Pain of Predomi-nantly Neuropathic Origin. Results From a General Population Survey. The J Pain 2006;7:281-9.
15. 15. Akram JM, Malik AN. Frequency of chronic neuropathic pain and its association with depression in the elderly in Pakistan. J Pak Med Assoc. 2019 Dec;69(12):1907-9.
16. 16. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevelance of chronic pain in the UK: a systematic review and meta-analyses of population studies. BMJ Open 2016 Jun 20;6(6):e010364.
17. 17. Molton IR, Terrill AL. Overview of persistent pain in older adults. Am Psychol 2014;69:197-207.
18. 18. Martin CM, Saleeby LG. All pain is not the same: an overview of neuropathic pain in the elderly. Consult Pharm. 2007 Apr;22(4):283-94.
19. 19. Alkhatatbeh M. Abdul-Razzak KK. Neuropathic pain is not associated with serum vitamin D but is associated with female gender in patients with type 2 diabetes mellitus. BMJ Open Diabetes Res Care. 2019 Jun 12;7(1):e000690.
20. 20. Sharma D, Brandow AM. Neuropathic pain in individuals with sickle cell disease. Neurosci Lett. 2020 Jan 1;714:134445.
21. 21. Boogaard S, Heymans MW, De Vet HCW, et al. Predictors of Persistent Neuropathic Pain-A Systematic Review. Pain Physi-cian. Sep-Oct 2015;18(5):433-57.
22. 22. Sertkaya BS, Fırat SB. Fizik tedavi polikliniğine kas iskelet sistemi ağrısı ile başvuran hastalarda nöropatik ağrı sıklığı (Uzmanlık Tezi). Antalya: Akdeniz Üniversitesi; 2015.
23. 23. Karasugi T, Ide J, Kitamura T, et al. Neuropathic pain in pati-ents with rotator cuff tears. BMC Musculoskelet Disord. 2016 Nov 2;17(1):451.
24. 24. Kudel I, Hopps M, Cappelleri JC, et al. Characteristics of patients with neuropathic pain syndromes screened by the pa-inDETECT questionnaire and diagnosed by physician exam. J Pain Res. 2019 Jan 7;12:255-68.
25. 25. Omoke NI, Amaraegbulam PI. Low back pain as seen in ortho-pedic clinics of a Nigerian Teaching Hospital. Niger J Clin Pract. Mar-Apr 2016;19(2):212-7.
26. 26. Koçoğlu D, Özdemir L. Yetişkin nüfusta ağrı ve ağrı inançları-nın sosyo-demografik ekonomik özelliklerle ilişkisi. Ağrı 2011;23(2):64-70.