Abstract
Objective
Descriptors provided by patients with neuropathic low back pain (NLBP) with or without spinally referred leg pain are frequently used by clinicians to help to identify the predominant pain mechanisms. Indeed, many neuropathic screening tools are primarily based on subjective descriptors to determine the presence of neuropathic pain. There is a need to systematically review and analyse the existing evidence to determine the validity of such descriptors in this cohort.
Methods
Ten databases were systematically searched. The review adhered to PRISMA and CRD guidelines and included a risk of bias assessment using QUADAS-2. Studies were included if they contained symptom descriptors from a group of NLBP patients +/− leg pain. Studies had to include a reference test to identity neuropathic pain from other pain mechanisms.
Results
Eight studies of 3099 NLBP patients were included. Allodynia and numbness were found to discriminate between NLBP and nociceptive LBP in four studies. Autonomic dysfunction, (changes in the colour or appearance of the skin), was also found to discriminate between the groups in two studies. Dysesthesia identified NLBP in 5/7 respectively. Results from studies were equivocal regarding pain described as hot/burning cold and paroxysmal pain in people with NLBP.
Conclusion
Subjectively reported allodynia and numbness would suggest a neuropathic pain mechanism in LBP. Dysesthesia would raise the suspicion of NLBP. More research is needed to determine if descriptors suggesting autonomic dysfunction can identify NLBP. There is poor consensus on whether other descriptors can identify NLBP.
Transparency
Declaration of funding
There was no sponsorship or funding received.
Declaration of financial/other relationships
There are no relationships to be declared. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
Both authors were involved in the conception and design, analysis and interpretation of the data; the drafting of the paper and revising it critically for intellectual content; and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.
Acknowledgements
No assistance in the preparation of this article is to be declared