None listed
Conditions
Brief summary
Low back pain is one of the most common health problems and affects 80 – 85% of people over their life time. Low back-related leg pain or sciatica is a common variation of low back pain. Although the prognosis for sciatica is good in most patients, up to 30% of patients continue to have pain for 1 year or longer. People with sciatica may or may not present with signs of nerve damage and associated nerve-related pain (neuropathic pain). It is important to determine the presence of altered nerve function as this (i) may contribute to people having persistent pain and/or disability and both are associated with greater health costs and poorer patient outcomes; (ii) will help direct more targeted treatment for the underlying condition such as specific pharmaceutical intervention for the treatment of neuropathic pain or surgical intervention in case of nerve root compromise. Targeted treatment may prevent the transition to persistent pain and associated poorer health outcomes and greater health economic burden. This study will investigate responses to various sensory stimuli (to heat and cold, to light touch and pressure, to pin-prick and vibration) that can be used to assess nerve fibre dysfunction. We will explore the correspondence of quantitative laboratory sensory testing with simple bedside sensory testing in patients with sciatica and compare findings with a healthy population that is age and gender matched. Should the bedside examination findings match the laboratory findings, then bedside examination may potentially replace time-consuming laboratory testing in the future. We will also investigate if sensory examination findings may be associated with the persistency of pain and functional status at 3 and 12 months follow-up in patients with sciatica. It is anticipated that there will be sub-groups of patients with differing sensory profiles. Sensory profiles of enhanced pain sensitivity will be associated with pain persistency and functional status at 3 and 12 months follow-up. The outcome of the study will inform clinical pathways to optimise time and cost efficient health outcomes for this patient cohort.
Interventions
Quantitative sensory testing (QST): Standardised QST will be performed according to the QST protocol of German Research Network on Neuropathic pain. The protocol includes the following assessments: cold and warm detection thresholds; the number of paradoxical heat sensations during the procedure of alternating warm and cold stimuli; cold and heat pain thresholds; mechanical detection threshold; mechanical pain threshold; stimulus-response functions: mechanical pain sensitivity and dynamic mechan
Quantitative sensory testing (QST): Standardised QST will be performed according to the QST protocol of German Research Network on Neuropathic pain. The protocol includes the following assessments: cold and warm detection thresholds; the number of paradoxical heat sensations during the procedure of alternating warm and cold stimuli; cold and heat pain thresholds; mechanical detection threshold; mechanical pain threshold; stimulus-response functions: mechanical pain sensitivity and dynamic mechanical allodynia; wind-up ratio; vibration detection threshold and pressure pain threshold. The clinical assessment tool, Standardized Evaluation of Pain (StEP), used for the identification of neuropathic pain in patients with lumbar radiculopathy, will be applied. The tool consists of a short interview and bedside sensory examination including: assessment of light touch and vibration sense, thermal, pinprick and pressure sensitivity and straight leg raise testing. QST measurements will be taken from the main pain area nominated by the patient, as required for the assessment of neuropathic pain, and the contralateral side and from the ipsilateral hand dorsum as a remote control site, plus thermal and mechanical detection thresholds will be assessed in the relevant dermatome (L5, S1) on the symptomatic side. QST and bedside sensory examination will be administered just once. Participants will be followed up by questionnaires at 3 months and 12 months after initial assessment
Sponsors
Brigitte Tampin
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
Patients: symptom duration of > 3 months; radicular leg pain in L5 or S1 dermatomal distribution; intensity of leg pain is higher than intensity of low back pain Healthy control group: Subjects with a history of current pain or a chronic pain condition or any of the exclusion criteria described for the patient group will be excluded, including taking medications that influence pain perception (e.g. analgesics, non-steroidals, antidepressants).
Exclusion criteria
diabetes, vascular disease; other neurological or psychiatric disease; a history of any previous disorders that potentially might affect the sensation in the contralateral side and in the hand (negative control site) to be tested and an insufficient level of English to understand and fill out the questionnairesa.
Outcome results
None listed