Review
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World J Rheumatol. Nov 12, 2014; 4(3): 54-61
Published online Nov 12, 2014. doi: 10.5499/wjr.v4.i3.54
Diagnosis and pharmacologic management of neuropathic pain among patients with chronic low back pain
Ferdi Yavuz, Umut Guzelkucuk
Ferdi Yavuz, The Clinic of Physical Medicine and Rehabilitation, Military Hospital of Etimesgut, 06790 Ankara, Turkey
Umut Guzelkucuk, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Centre, Gulhane Military Medical Academy, 06790 Ankara, Turkey
Author contributions: Guzelkucuk U performed the review of literature; Yavuz F written and revised the article.
Correspondence to: Ferdi Yavuz, MD, The Clinic of Physical Medicine and Rehabilitation, Military Hospital of Etimesgut, The Street of Erler, 06790 Ankara, Turkey. ferdiyavuz@yahoo.com
Telephone: +90-312-3461311 Fax: +90-312-2911009
Received: June 1, 2014
Revised: September 28, 2014
Accepted: October 14, 2014
Published online: November 12, 2014
Abstract

Chronic low back pain consists of both nociceptive and neuropathic mechanisms and can be classified as a mixed pain syndrome. Neuropathic component of chronic low back pain has often been under-recognized and under-treated by the physicians. Recent studies have demonstrated that approximately 20%-55% of chronic low back pain patients have neuropathic pain symptoms. An altered peripheral, spinal, and supraspinal processing of pain arising as a result of a lesion affecting the nerves system are the major contributor to neuropathic low back pain. The clinical evaluation is still the gold standard for assessment and diagnosis of neuropathic low back pain. Although diagnosis can be difficult due to the lack of reliable gold standard diagnostic test for neuropathic low back pain, screening tools may help non-specialists, in particular, to identify potential patients with neuropathic low back pain who require further diagnostic evaluation and pain management. Several screening tools for neuropathic pain have been developed and tested with different patient populations. Among the screening tools, the painDETECT questionnaire and the Standardized Evaluation of Pain are validated in patients with low back pain. The Standardized Evaluation of Pain may lead to more effective in discriminating between neuropathic and nociceptive pain in patients with low back pain according to the higher rate of sensitivity and its validity in patients with low back pain. However, the most appropriate approach is still to combine findings on physical and neurologic examinations and patient’s report in distinguishing neuropathic pain from nociceptive pain. The clinical examination including bedside sensory tests is still the best available tool for assessment and diagnosis neuropathic pain among patients with chronic low back pain. Due to the fact that chronic low back pain consists of both nociceptive and neuropathic mechanisms, a multimodal treatment approach is more rational in the management of patients with chronic low back pain. Therefore, combination therapy including drugs with different mechanisms of action should be given to the patients with chronic low back pain.

Keywords: Low back pain, Neuropathic, Pharmacotherapy, Screening, Questionnaire

Core tip: Neuropathic component of chronic low back pain has often been under-recognized and under-treated by the physicians. Recent studies have demonstrated that approximately 20%-55% of chronic low back pain patients have neuropathic pain symptoms. The clinical examination including bedside sensory tests is still the best available tool for assessment and diagnosis neuropathic pain among patients with chronic low back pain. Combination therapy including drugs with different mechanisms of action should be given to the patients with chronic low back pain.