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Subgrouping of low back pain (LBP) patients may be improved when pain drawings are combined with the painDETECT (PD-Q) questionnaire.
Low back pain is
the condition that has affected the population from all geographical areas,
gender and ages. There are many mechanisms associated with pain. The pain
drawings give way towards understanding the mechanisms of pain for the easy
classification of low back pain. It also aids in speculating the outcomes of
treatment.
Subgrouping of
low back pain (LBP) patients may be improved when pain drawings are combined
with the painDETECT (PD-Q) questionnaire. We hypothesized that (1) different
LBP subgroups determined by their pain radiation show different clinical
patterns and (2) the occurrence of neuropathic symptoms depends on pain
radiation.
A total of 19,263
acute (< 6 weeks’ duration), subacute (6 to 12 weeks), and chronic (> 3
months) LBP patients were allocated prospectively into 4 groups based on the
location of pain drawings on a manikin and compared regarding neuropathic pain
components, functionality, depression, pain intensity, and surgical
interventions. All items were investigated at baseline and follow-up visits.
Group I was composed of patients with axial LBP without radiating pain; group
II, LBP with radiation into the thigh; group III, LBP with radiation into the
shank; and group IV, LBP with radiation into the feet. Side-dependent pain
radiation was assessed additionally.
Depression,
functionality, and pain intensity showed no clinically relevant differences,
whereas PD-Q scores and the probability to rate positive for neuropathic pain
increased with more distally radiating pain. Surgery and medication intake were
most frequent in group IV. Follow-up analyses showed that only axial LBP became
more neuropathic, whereas pain intensity decreased over time.
Radicular
patterns of pain drawings in LBP patients indicate severe pain conditions with
the most neuropathic components, while axial LBP has the fewest. For the
categorization of LBP, pain drawings help explain the underlying mechanism of
pain, which might further improve mechanism-based treatment when used in
clinical routines and research.
Pain Practice
Pain Drawings Improve Subgrouping of Low Back Pain Patients
Philipp Hüllemann et al.
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