Sensory symptoms in low back pain—how do they matter?

Abstract

Objective: Successful treatment of chronic low back pain (LBP) is difficult in clinical practice and hard to measure in trials. One reason might be the use of insufficient outcome parameters. The aim was to investigate the importance of typical clinical characteristics of chronic LBP on QoL and functionality.

Methods: A total of 51 patients with chronic LBP (19 with, 32 without radiculopathy) were investigated with different questionnaires.

Results: Burdening symptoms differed in frequency, intensity and impairment of QoL and functionality between patients with and without radiculopathy and between the area of pain within the same patient, i.e. between back and leg. Symptoms of nerve affection such as prickling pain and numbness were rated higher in the area of radiating pain than on the back in radiculopathy, and typical neuropathic pain symptoms such as burning pain, prickling, spontaneous pain, and feeling of deep pressure and pain at the beginning of movement were rated with a higher impairment of QoL and functionality in patients with compared to those without radiculopathy. Furthermore, intensity, impairment of QoL, and functionality were not necessarily reported in association with one another: some patients were highly impaired in QoL or functionality, despite a moderate-to-low pain intensity, whereas others suffered from severe pain, but were less impaired in QoL or functionality.

Conclusion: Results suggest the consideration of impairment of QoL and functionality in addition to symptom intensity for treatment evaluation of chronic LBP. This can help to improve overall well-being of the patients and enhance efficacy in clinical pain trials and patient-centered treatment.

Keywords:

• Lower back pain
• quality-of-life
• functionality
• outcome parameters
• treatment evaluation

Transparency

Declaration of funding

This research was supported by Grünenthal GmbH. The sponsor was not involved in study design, data collection, data analysis, manuscript preparation, and/or publication decisions.

Declaration of financial/other relationships

J Gierthmühlen has received speaker fees and travel support from Pfizer, Grünenthal, Sanofi Pasteur MSD GmbH, TAD Pharma, and consultancy fees from Glenmark. JH received travel grants from Astellas, Genzyme, Grünenthal, and Pfizer, and honoria as a speaker from Pfizer. PH has received speaking fees from Genzyme, and travel reimbursement from Grünenthal. MR has received travel grants from Astellas, Pfizer, and Grünenthal. RB has received grants/research support from Pfizer, Genzyme, Grüunenthal, and Mundipharma. He is a member of the EU Project No 633491: DOLORisk. A member of the IMI "Europain" collaboration, and industry members of this are: Astra Zeneca, Pfizer, Esteve, UCBPharma, Sanofi Aventis, Grünenthal, Eli Lilly, and Boehringer Ingelheim. German Federal Ministry of Education and Research (BMBF): Member of the ERANET NEURON/IM-PAIN Project. German Research Network on Neuropathic Pain, NoPain system biology, German Research Foundation (DFG). He has received speaking fees from Pfizer, Genzyme, Grünenthal, Mundipharma, Sanofi Pasteur, Medtronic, Eisai, Lilly, Boehringer Ingelheim, Astellas, Desitin, Teva Pharma, Bayer-Schering, MSD, and bioCSL. He has been a consultant for Pfizer, Genzyme, Grünenthal, Mundipharma, Allergan, Sanofi Pasteur, Medtronic, Eisai, Lilly, Boehringer Ingelheim, Astellas, Novartis, Bristol-Myers-Squibb, Biogenidec, AstraZeneca, Merck, Abbvie, Daiichi Sankyo, Glenmark Pharmaceuticals, Genentech, and bioCSL. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Acknowledgments

We are indebted to the subjects who participated in the study for their consent and co-operation.