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The Relationship Between Neuropathic Pain and Spinal Alignment

Independent Risk Factors for Low Quality of Life in Middle-Aged and Elderly People

Imagama, Shiro MD, PhD; Ando, Kei MD, PhD; Kobayashi, Kazuyoshi MD, PhD; Seki, Taisuke MD, PhD; Hamada, Takashi MD, PhD; Machino, Masaaki MD; Ota, Kyotaro MD; Tanaka, Satoshi MD; Morozumi, Masayoshi MD; Kanbara, Shunsuke MD; Ito, Sadayuki MD; Ishiguro, Naoki MD, PhD; Hasegawa, Yukiharu MD, PhD∗,†

doi: 10.1097/BRS.0000000000003073
CLINICAL CASE SERIES
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Study Design. Prospective research in middle-aged and elderly people.

Objective. To investigate low back pain (LBP) and neuropathic pain (NeP); spinal alignment and range of motion (ROM); spinal degenerative changes in plain radiography; osteoporosis; muscle strength; and physical ability as possible risk factors for poor quality of life (QOL).

Summary of Background Data. The aging of society has led to an increase in elderly people with chronic pain, including LBP and NeP. However, there has been no analysis of NeP and spinal sagittal alignment as potential risk factors for decreased QOL in the healthy general population.

Methods. The subjects were 1128 people (male 473, female 655, average age: 64.3 yrs) who attended an annual health checkup in Yakumo study. The prevalence of LBP and sciatica were investigated using a visual analogue scale (VAS), and NeP was defined as more than or equal to 13 points on the painDETECT questionnaire. Sagittal spinal alignment with spinal ROM was also measured. Body mass index, muscle strength, physical ability, osteoporosis, and lumbar degenerative changes were measured, and 36-item short-form health survey (SF-36) was used for QOL analysis.

Results. NeP was present in 113 people (10%). The NeP (+) subjects had significantly more severe pain, lower gait speed, higher osteoporosis rate, lumbar kyphosis, and larger spinal inclination (P < 0.01) compared with NeP (–) subjects. On SF-36, physical and mental QOL were significantly lower for NeP (+) subjects (P < 0.0001). In multivariate logistic regression analysis adjusted for age and sex, NeP (+) (odds ratio [OR]: 3.01), positive spinal inclination (OR: 1.14), and high VAS for LBP (OR: 1.04) were identified as risk factors for low physical QOL, and NeP (+) (OR: 5.32) was the only significant risk factor for low mental QOL.

Conclusion. These results suggest that interventions for NeP and other identified risk factors may contribute to improvement of low physical and mental QOL in middle-aged and elderly people.

Level of Evidence: 2

In multivariate logistic regression analysis in 1128 elderly people, neuropathic pain (NeP)(+) (odds ratio [OR]: 3.01), positive spinal inclination (OR: 1.14), and high visual analogue scale for low back pain (OR: 1.04) were identified as risk factors for low physical quality of life (QOL), and NeP (+) (OR: 5.32) was the only significant risk factor for low mental QOL.

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

Department of Rehabilitation, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan.

Address correspondence and reprint requests to Shiro Imagama, MD, PhD, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan; E-mail: imagama@med.nagoya-u.ac.jp

Received 24 December, 2018

Revised 13 March, 2019

Accepted 25 March, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

Japanese Ministry of Health, Labor, and Welfare Grants-in Aid for Scientific Research (C) (18K09102) funds were received in support of this work.

No relevant financial activities outside the submitted work.

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