Significance of Pain Drawings in Low Back Pain Patients

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Significance of Pain Drawings in Low Back Pain Patients

Lower back pain (LBP) can be caused by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons in the lumbar spine. Typical sources of low back pain include:

- The large nerve roots in the low back that go to the legs may be irritated.

- The smaller nerves that supply the low back may be irritated

- The large paired lower back muscles may be strained

- The bones, ligaments or joints may be damaged

-  An inter-vertebral disc may be degenerating

For the categorization of LBP, pain drawings help explaining the underlying mechanism of pain, which might further improve the mechanism-based treatment when used in clinical routines and research. Sub-grouping of low back pain (LBP) patients may be improved when pain drawings are combined with the pain DETECT (PD-Q) questionnaire. Researchers hypothesized that different LBP subgroups determined by their pain radiation showed different clinical patterns and the occurrence of neuropathic symptoms depends on pain radiation.

In the analyses, a total of 19,263, sub-acute and chronic 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 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 the 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 to explain the underlying mechanism of pain, which might further improve mechanism-based treatment when used in clinical routines and research.   

Pain Practice
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