The assessment of the frequency of radicular pain, characteristics of neuropathic pain, neurological findings and the effects of them in patients with neck pain by DN4, lanss and paindetect
Neck pain can be defined as pain in the back of the neck between the C7 vertebra and occiput. Not only in this area, but also the pain behind the ear or chin, and radiating pain to shoulders, back and arms can be considered as neck pain. It is the most common musculoskeletal complaint after low back pain. Nearly 2/3s of adults suffer neck pain in some part of their lifetime and it is reported that the prevalence of neck pain is between 22-30%. Neck pain has two components as nociceptive and neuropathic.
The frequency of neuropathic pain tends to increase by age and it peaks at 50-54 ages. Neuropathic pain can be caused by the effects of degenerative lesions in nociceptive projection on the disc, mechanical compression of the nerve roots or induced inflammatory mediators by degenerated disc without any mechanical compression.
There are no golden standards in diagnosis and treatment of neck pain. The diagnostic value of physical examination and anamnesis has not been proved sufficiently yet. In suspicion of neuropathic pain, some self-assessed questionnaires, which have been shown their reliability and validity, are widely used. DN4, LANSS and PainDETECT are accepted scales in diagnosis of neuropathic pain. In this study, it is aimed that the frequency of radicular pain, the characteristics of neuropathic pain and neurologic findings effecting neck pain will be assessed by using these scales.
For this reason, a dataset has been established containing some demographical, anxiety, depression, panic and sleep disorders information of 124 patients with neck pain as well as their mood disorders. The scores of three scales were significantly different between the patients with radicular and nociceptive pain (p< .05). Furthermore, the difference between the groups is statistically significant for diagnosis, VAS, anxiety and depression scores. The effect of radicular pain on pain duration, flammable pain, itching, tingling and chilling was found significant (p< .05).
Moreover, it was shown that the effect of radicular pain on sleeping, physical activity, job-school life and sexual way of life is negative (p< .05). The reliability of DN4 and PainDETECT were about 90% and Cronbach’s alpha value for LANSS was near 50%. There were significant correlations (r=~90%) between three scales.
We think that these questionnaires can be used to determine the potential neuropathic pain and to guide for relief of pain. We suggest that the clinicians should use these scales since they are easy to apply and assess to discriminant of neuropathic pain from nociceptive pain.
-Study made by Mehmet Aydoğmuş