A number of studies have demonstrated an association of neuropathic pain and chronic low back pain (CLBP), but the outcome difference in each medical management is poorly understood. This study is aimed to investigate treatment patterns of neuropathic pain in CLBP patients and to explore patient-reported outcomes (PROs) including quality of life (QoL) and functional disability by treatment patterns. Data were extracted from the neuropathic low back pain (NLBP) outcomes research. It was a multicenter and cross-sectional study in which 1200 patients were enrolled at 27 general hospitals, from 2014 to 2015. Of total, 478 patients classified as neuropathic pain were used for this subgroup analysis. The patients were divided into 2 groups according to treatment patterns (with vs. without the targeted therapy [TT] of neuropathic pain). Demographic and clinical features were collected by chart reviews and PROs were measured by patient’s survey. QoL was assessed by EuroQoL 5-dimension (EQ-5D) questionnaire. Functional disability was measured by the Quebec Back Pain Disability Scale (QBPDS). Multiple linear regression analyses were conducted to compare the PROs between TT group and non-targeted therapy (nTT) group. Among the NLBP patients (mean age 63years, female 62%), EQ-5D index, EuroQoL-Visual Analog Scale (EQ-VAS), and QBPDS Scores (mean ± standard deviation) were 0.40 ± 0.28, 54.98 ± 19.98, and 46.03 ± 21.24, respectively. Only 142 (29.7%) patients had pharmacological TT of neuropathic pain. Univariate analyses revealed no significant mean differences between TT group and nTT group in the EQ-5D index (0.41 ± 0.27 and 0.39 ± 0.28), EQ-VAS (56.43 ± 18.17 and 54.37 ± 20.69), and QBPDS (45.31 ± 21.32 and 46.31 ± 21.24). After adjustment with covariates, TT group had higher scores of EQ-5D index (b = 0.07; P < 0.01) and EQ-VAS (b = 4.59; P < 0.05) than the nTT group. The TT group’s QBPDS score was lower than the nTT group, although its statistical significance still has not been reached (b = 4.13; P = 0.07). We found that considerable proportion of the NLBP patients remains untreated or undertreated. Although TT group had significantly better QoL than nTT group, only 29.7% of NLBP patients had pharmacological TT. Therefore, clinicians should consider using TT for better QoL of neuropathic pain patients.
Bibliographical noteFunding Information:
This research was sponsored by Pfizer Pharmaceuticals Korea Ltd. JTH and J-HK are first co-authors. The authors report no conflicts of interest. aDepartment of Neurosurgery, The catholic university of Korea, St. Vincent’s hospital & Eunpyung St. Mary’s Hospital, Suwon, bDepartment of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Gyeonggi-do, cDepartment of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, dDepartment of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, eDepartment of Neurosurgery, Kangbuk Samsung Hospital, Seoul, fDepartment of Neurosurgery, Gachon University Gil Medical Center, Incheon, gDepartment of Neurosurgery, Korea University Guro Hospital, Seoul, hDepartment of Neurosurgery, Chonnam National University Hospital, Kwangju, iDepartment of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, jDepartment of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, kDepartment of Neurosurgery, Soonchunhyang University Hospital Bucheon, Gyeonggi-do, lDepartment of Neurosurgery, Yeungnam university Hospital, Daegu, mDepartment of Neurosurgery, Pusan National University Hospital, Busan, nDepartment of Neurosurgery, Inje University Industry Academic Cooperation Foundation, Wonju, Korea, oDepartment of Neurosurgery, Sun Medical Center, Kerala, India, pDepartment of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University Health System, qDepartment of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Seoul, rDepartment of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, sDepartment of Orthopedic Surgery, Seoul National University Hospital, Seoul, tDepartment of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, uDepartment of Orthopedic Surgery, Seoul St. Mary’s Hospital of the Catholic University of Korea, vDepartment of Orthopedic Surgery, Kyung Hee University Hospital, Seoul, wDepartment of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, xDepartment of Orthopedic Surgery, Pusan National University Hospital, Busan, yDepartment of Orthopedic Surgery, Korea University Anam Hospital, Seoul, zDepartment of Orthopedic Surgery, Incheon St. Mary’s Hospital of the Catholic University of Korea, Incheon, aaDepartment of Orthopedic Surgery, Korea University Ansan Hospital, Gyeonggi-do, bbOutcomes Research/Real World Data, Corporate Affairs & Health and Value, Pfizer Pharmaceuticals Korea Ltd., ccDepartment of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea. ∗Correspondence: Keun-Su Kim, Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul06273, Korea (e-mail: SPINEKKS@yuhs.ac); Chong-Suh Lee, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea (e-mail: firstname.lastname@example.org).
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