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Prognosis of patients with neuropathic low back-related leg pain: An exploratory study using prospective data from UK primary care

Harrisson, Sarah A; Ogollah, Reuben; Dunn, Kate M; Foster, Nadine E; Konstantinou, Kika

Authors

Reuben Ogollah

Nadine E Foster

Kika Konstantinou



Abstract

This prospective cohort study investigates the prognosis of patients with neuropathic low back-related leg pain (LBLP) consulting in UK primary care. Data from 511 patients were collected using standardised baseline clinical examinations (including MRI scan findings), self-report questionnaires at baseline, 4-months, 12-months and 3-years. Cases of possible neuropathic pain (NP) and persistent-NP were identified using either of two definitions: i) clinical diagnosis of sciatica, ii) self-report version of Leeds Assessment for Neurological Symptoms and Signs (s-LANSS). Mixed-effects models compared pain intensity (highest of mean leg or mean back pain (0-10 NRS)) over 3-years between persistent-NP vs non-persistent NP based on i) clinical diagnosis, ii) s-LANSS. Logistic regression examined associations between potential prognostic factors and persistent-NP at 4-months based on the two NP definitions. At 4-months, using both definitions: i) approximately 4 out of 10 patients had persistent-NP, ii) mean pain intensity was higher for patients with persistent-NP at all follow-up points compared to those without, iii) only pain self-efficacy was significantly associated with persistent-NP (s-LANSS: OR 0.98, sciatica: 0.98), but it did not predict cases of persistent-NP in either multivariable model. Based on factors routinely collected from self-report and clinical examination, it was not possible to predict persistent-NP in this population. PERSPECTIVE: This study provides evidence that neuropathic back-related leg pain in patients consulting in primary care is not always persistent. Patients with persistent neuropathic pain had worse outcomes than those without. Neither leg pain intensity, pain self-efficacy nor MRI scan findings predicted cases of persistent neuropathic pain in this patient population. [Abstract copyright: Copyright © 2023. Published by Elsevier Inc.]

Journal Article Type Article
Acceptance Date Sep 24, 2023
Online Publication Date Sep 29, 2023
Publication Date Sep 29, 2023
Deposit Date Oct 6, 2023
Publicly Available Date Oct 6, 2023
Journal The Journal of Pain
Print ISSN 1526-5900
Publisher Elsevier
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1016/j.jpain.2023.09.016
Keywords Anesthesiology and Pain Medicine; Neurology (clinical); Neurology; spine-related leg pain; radicular pain; epidemiology; prognostic factor; clinical course
Additional Information This article is maintained by: Elsevier; Article Title: Prognosis of patients with neuropathic low back-related leg pain: An exploratory study using prospective data from UK primary care; Journal Title: The Journal of Pain; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jpain.2023.09.016; Content Type: article; Copyright: © Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc