ORIJINAL ARAŞTIRMA
Kronik Bel Ağrılı Hastalarda Nöropatik Ağrı Skalaları ve Disabilitenin Değerlendirilmesi
The Assessment of the Neuropathic Pain Scales and Disability in Patients with Chronic Low Back Pain Syndrome
Received Date : 19 Aug 2019
Accepted Date : 12 Mar 2020
Available Online : 01 May 2020
Emel ATARa, Korhan Barış BAYRAMa, Özlem YOLERİa, Hikmet KOÇYİĞİTa
aİzmir Kâtip Çelebi University Atatürk Training and Research Hospital, Department of Physical Medicine and Rehabilitation, İzmir, TURKEY
Doi: 10.31609/jpmrs.2019-71039 - Makale Dili: EN
J PMR Sci. 2020;23(2):62-8
ÖZET
Amaç: Kronik bel ağrısı, nosiseptif ve nöropatik ağrı oluşum
mekanizmalarının bir kombinasyonu ile karakterizedir. Çalışmanın
amacı farklı nöropatik ağrı skalalarını kullanarak kronik bel ağrılı hastalarda
nöropatik ağrı bileşenini belirlemek ve bel ağrısı ile fiziksel yetersizlik
arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler:
Çalışma kronik bel ağrılı 102 hasta ile yürütüldü. Hastalar klinik ve demografik
olarak değerlendirildi. Nöropatik ağrı komponentleri ve ağrı
şiddeti LANSS Ağrı Skalası (The Leeds Assessment of Neuropathic
Pain Symptoms and Signs), PainDETECT, DN4 skalası (Douleur Neuropathique
4 Questions) ve 10 cm’lik vizüel analog skala (VAS) ile; fiziksel
kısıtlılık İstanbul Bel Ağrısı Disabilite Indeksi ile değerlendirildi.
Bulgular: Hastaların yaş ortalaması 44,70±11,98 idi. LANSS kullanıldığında
%23,5 hasta, baskın olarak nöropatik ağrı bileşeni gösterdi.
Ayrıca nöropatik ağrı sıklığını PAIN-DETECT’te %18,6 ve DN4’te
%35,3 olarak bulduk. Tüm nöropatik ağrı skalalarına göre nöropatik
ağrının varlığı, İstanbul Bel Ağrısı Disabilite İndeksi skorları ile anlamlı
olarak ilişkiliydi (p<0,05). Sonuç: Nosiseptif ağrı, akut bel ağrısında
daha belirgin iken, kronik durumlarda nöropatik bileşen daha
belirgindir. Kronik bel ağrısının altında yatan mekanizmaları tanımlamak
önemlidir. Bel ağrılı hastalarda ağrının kronikliği ve hastalığın
ilerlemesi ancak uygun ve erken mekanizma hedefli tedavi yöntemleri
ile önlenebilir.
Anahtar Kelimeler: Kronik bel ağrısı; nöropatik ağrı
ABSTRACT
Objective: Chronic low back pain (LBP) is characterized
by a combination of nociceptive and neuropathic mechanisms of pain
generation. We aimed to determine the neuropathic component of LBP
and to evaluate its relation with physical disability. Material and Methods:
One hundred and two patients with chronic low back pain were included
in the study. The patients were evaluated clinically and
demographically. Neuropathic pain component and back pain intensity
were assessed using the different scales of Leeds Assessment of Neuropathic
Signs and Symptoms (LANSS), PAIN/DETECT and DN4 and
10-cm Visual Analog Scale (VAS); Physical disabilities of the patients
were also assessed by İstanbul Low Back Pain Disability Index
(ILBPDI). Results: The mean age of the patients was 44.70±11.98.
When LANSS was used, 23.5% patients demonstrated a predominantly
neuropathic pain component. We also found the frequency of neuropathic
pain as 18.6% in PAIN/DETECT and 35.3% in DN4. The presence of
neuropathic pain according to all neuropathic pain scales was significantly
correlated with the scores of ILBPDI (p<0.05). Conclusion: Nociceptive
pain is more prominent in acute LBP, whereas neuropathic
component is more prominent in chronic conditions. It is important to
identify the underlying mechanisms of chronic LBP. Chronicity of pain
and disease progression in LBP patients can only be prevented with
proper and early mechanisim-targeted treatment methods.
Keywords: Chronic low back pain; neuropathic pain
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