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

Abstract

This prospective cohort study investigates the prognosis of patients with neuropathic low back-related leg pain consulting in UK primary care. Data from 511 patients were collected using standardised baseline clinical examinations (including magnetic resonance imaging 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 2 definitions: 1) clinical diagnosis of sciatica, 2) 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 Numerical Rating Scale]) over 3-years between persistent-NP versus non-persistent-NP based on 1) clinical diagnosis, 2) s-LANSS. Logistic regression examined associations between potential prognostic factors and persistent-NP at 4 months based on the 2 NP definitions. At 4-months, using both definitions: 1) approximately 4 out of 10 patients had persistent-NP, 2) mean pain intensity was higher for patients with persistent-NP at all follow-up points compared to those without, 3) only pain self-efficacy was significantly associated with persistent-NP (s-LANSS: OR .98, sciatica: .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.

Citation

Harrisson, S. A., Ogollah, R., Dunn, K. M., Foster, N. E., & Konstantinou, K. (2024). Prognosis of patients with neuropathic low back-related leg pain: An exploratory study using prospective data from UK primary care. Journal of Pain, 25(2), 533-544. https://doi.org/10.1016/j.jpain.2023.09.016

• Journal Article Type: Article
• Acceptance Date: Sep 24, 2023
• Online Publication Date: Sep 29, 2023
• Publication Date: 2024-02
• Deposit Date: Oct 2, 2023
• Publicly Available Date: Dec 12, 2023
• Journal: Journal of Pain
• Print ISSN: 1526-5900
• Electronic ISSN: 1526-5900
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 2
• Pages: 533-544
• DOI: https://doi.org/10.1016/j.jpain.2023.09.016
• Keywords: Spine-related leg pain; radicular pain; epidemiology; prognostic factor; clinical course
• Public URL: https://nottingham-repository.worktribe.com/output/25649779
• Publisher URL: https://www.jpain.org/article/S1526-5900(23)00545-X/fulltext