Article thumbnail

Sensory Symptom Profiles and Co-Morbidities in Painful Radiculopathy

By Friederike Mahn, Philipp Hüllemann, Ulrich Gockel, Mathias Brosz, Rainer Freynhagen, Thomas R. Tölle and Ralf Baron

Abstract

Painful radiculopathies (RAD) and classical neuropathic pain syndromes (painful diabetic polyneuropathy, postherpetic neuralgia) show differences how the patients express their sensory perceptions. Furthermore, several clinical trials with neuropathic pain medications failed in painful radiculopathy. Epidemiological and clinical data of 2094 patients with painful radiculopathy were collected within a cross sectional survey (painDETECT) to describe demographic data and co-morbidities and to detect characteristic sensory abnormalities in patients with RAD and compare them with other neuropathic pain syndromes. Common co-morbidities in neuropathic pain (depression, sleep disturbance, anxiety) do not differ considerably between the three conditions. Compared to other neuropathic pain syndromes touch-evoked allodynia and thermal hyperalgesia are relatively uncommon in RAD. One distinct sensory symptom pattern (sensory profile), i.e., severe painful attacks and pressure induced pain in combination with mild spontaneous pain, mild mechanical allodynia and thermal hyperalgesia, was found to be characteristic for RAD. Despite similarities in sensory symptoms there are two important differences between RAD and other neuropathic pain disorders: (1) The paucity of mechanical allodynia and thermal hyperalgesia might be explained by the fact that the site of the nerve lesion in RAD is often located proximal to the dorsal root ganglion. (2) The distinct sensory profile found in RAD might be explained by compression-induced ectopic discharges from a dorsal root and not necessarily by nerve damage. These differences in pathogenesis might explain why medications effective in DPN and PHN failed to demonstrate efficacy in RAD

Topics: Research Article
Publisher: Public Library of Science
OAI identifier: oai:pubmedcentral.nih.gov:3090397
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles

Citations

  1. (2009). A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia:Differencesindemographicdataandsensorysymptoms.Pain146:34–40.
  2. (2008). Changes in Na(+) channel expression and nodal persistent Na(+) currents associated with peripheral nerve regeneration in mice.
  3. (1994). Classification of chronic pain: descriptions of chronic pain syndromes and definition of terms 2nd ed,
  4. (2008). Comparison of psychological and physical function in neuropathic pain and nociceptive pain: implications for cognitive behavioral pain management programs.
  5. (2002). Degeneration of myelinated efferent fibers induces spontaneous activity in uninjured C-fiber afferents.
  6. (2006). Differential spinal cord gene expression in rodent models of radicular and neuropathic pain.
  7. (2007). Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine (Phila Pa
  8. (2002). Evaluation of psychological status in chronic low back pain: comparison with general population.
  9. (2009). Gait abnormalities and inflammatory cytokines in an autologous nucleus pulposus model of radiculopathy. Spine (Phila Pa
  10. (1996). Immunohistochemical demonstration of sensory and autonomic nerve terminals in herniated lumbar disc tissue. Spine (Phila Pa
  11. (2004). Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9).
  12. (1977). Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression.
  13. (2007). Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain.
  14. (2009). Motor axon excitability during Wallerian degeneration.
  15. (2008). Neuropathic pain: redefinition and a grading system for clinical and research purposes.
  16. (2009). On the definitions and physiology of back pain, referred pain, and radicular pain.
  17. (2006). painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain.
  18. (2008). Paper versus electronic rating scales for pain assessment: a prospective, randomised, cross-over validation study with 200 chronic pain patients.
  19. (2007). Pseudoradicular and radicular low-back pain - A disease continuum rather than different entities? Answers from quantitative sensory testing.
  20. (2005). Psychometric properties of the Medical Outcomes Study Sleep measure.
  21. (1958). Sciatica and the intervertebral disc; an experimental study.
  22. (2010). The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy.
  23. (1992). The treatment of depression in chronic low back pain: review and recommendations.
  24. (2005). Topiramate in chronic lumbar radicular pain.