Prevalence of neuropathic pain in patients scheduled for lumbar spine surgery: Nationwide, multicenter, prospective study

Background: There is limited evidence about surgical outcomes after lumbar spinal surgery inpatients with neuropathic pain (NP) or the prevalence of NP proportions among patients withdegenerative lumbar diseases who are candidates for a surgical interventions.Objective: The objectives of this study were to investigate the prevalence of NP among patientsscheduled for lumbar spinal surgery and the relationship between health-related quality of life(HRQoL) and NP. This study also aimed to identify the risk factors related to NP and compare theclinical outcomes after surgical treatment between patients with and without NP.Study Design: This study was a nationwide, multicenter, prospective, and observational study. Itwas conducted from September 2011 to May 2013, and included a total of 1,109 patients who werescheduled for lumbar spinal surgery from 44 spinal centers (both orthopedics and neurosurgeons).Setting: Multicenter studyMethods: Patients were diagnosed of having NP if the Leeds Assessment of NeuropathicSymptoms and Signs (LANSS) pain scale was ≥ 12 points. The patients were investigated to assessthe differences in their clinical outcomes one week and 3 months after surgery and were followedupwith regards to pain and HRQoL to explore the risk factors affecting NP.Results: Of 1,109 recruited patients, 404 (36.4%) suffered from NP (mean age 62.06 years; 37.9%men) with mean LANSS score of 17.44 ±} 4.06, while 705 (63.6%) had nociceptive pain with meanLANSS score of 6.03 ±} 3.52. At baseline, patients with NP showed lower HRQoL and more severepain compared to nociceptive pain patients. However, 3 months after surgical treatment, the NPgroup showed greater improvement in pain NRS (P = 0.087) and EQ-5D (P = 0.029) as compared tonociceptive pain group. Longer symptom duration was identified as a risk factor for NP (OR 1.003,respectively, P = 0.020).Conclusion: There was a high prevalence of NP in Korean patients scheduled for lumbar spinesurgery, and these patients suffered greater pain and lower HRQoL than nociceptive pain patients.The more remarkable improvement NP patients showed after treatment highlights the importanceof appropriate diagnosis and treatment of NP.