Nociceptive pain assessed by the PainDETECT questionnaire may predict response to opioid treatment for chronic low back pain

Stone Sima; Samuel Lapkin; Zachary Gan; Ashish D. Diwan

doi:10.1016/j.heliyon.2024.e25834

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Nociceptive pain assessed by the PainDETECT questionnaire may predict response to opioid treatment for chronic low back pain

Stone Sima, Samuel Lapkin, Zachary Gan and Ashish D. Diwan

Heliyon, Vol.10(3), e25834

15/02/2024

DOI: https://doi.org/10.1016/j.heliyon.2024.e25834

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Abstract

Low back pain

Medication efficacy

Neuropathic pain

Nociceptive pain

Opioids

PainDETECT

Pharmacological management

Introduction The pharmacological management of chronic low back pain (LBP) is complex. The World Health Organisation recommends a laddered approach to pain medication usage. The PainDETECT questionnaire distinguishes between neuropathic pain (NeP), nociceptive pain (NoP), and ambiguous pain. By elucidating the difference in medication efficacy between these groups, clinicians can provide a tailored treatment plan to manage patient's pain. This study aimed to investigate the relationship between pharmacological treatments, pain categorizations, and medication efficacy as reported by patients. Methods A secondary retrospective analysis of a prospectively collected database was conducted involving 318 consecutively recruited patients, aged 18 years and above, who completed PainDETECT, medication history and patient reported medication efficacy questionnaires. Medication history was categorized into four lines of treatment: first line (paracetamol ± non-prescribed anti-inflammatories), second line (prescribed anti-inflammatories), third line (anticonvulsants/neuromodulators) and fourth line (opioids). Medication efficacy was measured using a three-point Likert scale: effective (+2), somewhat effective (+1), no effect (0). Findings The study included 120, 50, 54 and 94 patients on first line, second line, third line and fourth line treatment, respectively. The NeP group had higher mean numerical rating scale (NRS) compared to NoP group in all four lines of treatment (8.10 ± 1.59 vs. 5.47± 2.27, p < 0.001, 8.64± 1.43 vs. 5.52± 1.86, p < 0.001, 8.00± 1.07 vs. 6.37± 2.39, p < 0.01, and 8.05± 1.73 vs. 7.2± 1.29, p < 0.05). When confounding for severity of LBP as measured by NRS, the distribution of medication efficacy significantly differed amongst the NeP, ambiguous and NoP groups in patients undergoing fourth line pharmacological treatment (r2 = 8.623, p < 0.05). The NoP group exhibited significantly higher medication efficacy compared to the NeP group (U = 14.038, p < 0.05). There was no significant difference in medication efficacy across the pain classifications for first, second- and third-line treatment. Interpretation Opioids was the only line of treatment more effective in targeting NoP, as determined by the PainDETECT questionnaire, compared to NeP. This pioneering study illustrates the complex nature of pharmacological management for chronic LBP. It underscores the importance of tailoring pharmacological treatment plans to fit individual pain profiles and expectations instead of adopting a blanket approach to pain management.

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Title: Nociceptive pain assessed by the PainDETECT questionnaire may predict response to opioid treatment for chronic low back pain
Creators: Stone Sima - University of New South Wales
Samuel Lapkin - Southern Cross University
Zachary Gan - University of New South Wales
Ashish D. Diwan - University of New South Wales
Publication Details: Heliyon, Vol.10(3), e25834
Publisher: Elsevier Ltd
Identifiers: 991013167593402368
Academic Unit: Faculty of Health; Nursing
Language: English
Resource Type: Journal article

Nociceptive pain assessed by the PainDETECT questionnaire may predict response to opioid treatment for chronic low back pain

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