ORIJINAL ARAŞTIRMA
Lateral Epikondilitli Hastalarda Nöropatik Ağrının Sıklığı ve Özürlülüğe Etkisi
Frequency of Neuropathic Pain and its Effect on Disability in Patients with Lateral Epicondylitis
Received Date : 22 Feb 2022
Accepted Date : 13 Sep 2022
Available Online : 15 Sep 2022
Dilek EKER BÜYÜKŞİRECİa, Ayla ÇAĞLIYAN TÜRKa
aDepartment of Physical Medicine and Rehabilitation, Hitit University Erol Olçok Training and Research Hospital, Çorum, Türkiye
Doi: 10.31609/jpmrs.2022-89046 - Makale Dili: EN
J PMR Sci. 2023;26(1):43-7
ÖZET
Amaç: Bu çalışmada amaç, lateral epikondilitli (LE) hastalarda
nöropatik ağrı sıklığının ve nöropatik ağrının özürlülüğe etkisinin
değerlendirilmesidir. Gereç ve Yöntemler: Çalışmaya 18 yaş üstü LE’li 88
hasta davet edildi. Hastalar PainDETECT Ölçeği [PainDETECT Questionnaire
(PDQ)] ile nöropatik ağrının varlığına göre gruplandırıldı: Nöropatik
ağrı [neuropathic pain (NEP)] grubuna PDQ skoru ≥19 olan 26 hasta ve nosiseptif
ağrı [nociceptive pain (NOP)] grubuna PDQ skoru ≤12 olan 50 hasta
dâhil edildi. Ağrı düzeyi, görsel analog skalası [visual analogue scale
(VAS)] (ilk vizitteki VAS, son 4 haftadaki en kötü ve ortalama VAS skoru)
ile özürlülük Hızlı-Kol, Omuz ve El Sorunları [Quick-Disability of Arm,
Shoulder and Hand (Quick-DASH)] Ölçeği ile değerlendirildi. Bulgular:
LE’li hastaların 26’sında (%29,5) NEP, 50’sinde (%56,8) NOP saptandı.
İlk vizitteki VAS, son 4 haftadaki en kötü VAS ve ortalama VAS skorları
NEP grubunda anlamlı olarak daha yüksekti (sırasıyla p=0,003, p=0,006,
p=0,004). Quick-DASH skoru NEP’de 64,62 (55,06-75), NOP gruplarında
45,12 (28,93-52,81) idi (p<0,001). NEP grubunda, ilk vizitteki VAS skoru,
son 4 haftadaki en kötü VAS ve ortalama VAS skorları ile PDQ skorları
arasında pozitif korelasyon bulundu (sırasıyla r=0,652 p<0,001, r=0,436
p=0,026, r=0,661 p<0,001). Quick-DASH skoru NEP için bağımsız prognostik
faktörler olarak bulundu (p=0,001). Sonuç: NEP, LE hastalarda
artmış özürlülüğe neden olabilir, bu nedenle bu hasta grubunda NEP’in
değerlendirilmesi gereklidir.
Anahtar Kelimeler: Lateral epikondilit, nöropatik ağrı, özürlülük
ABSTRACT
Objective: To evaluate the frequency of neuropathic pain and
its effect on disability in patients with lateral epicondylitis (LE). Material
and Methods: Eighty eight patients with LE over the age of 18 were invited
to the study. Patients were grouped according to the presence of neuropathic
pain using the PainDETECT Questionnaire (PDQ): 26 patients with
score of ≥19 in neuropathic pain (NEP) group and 50 patients with score of
≤12 in nociceptive pain (NOP) group. Pain level was assessed by visual analogue
scale (VAS) (VAS at first visit, worst and average VAS scores in last
4 weeks) and disability by Quick-Disability of Arm, Shoulder and Hand
(Quick-DASH) Scale. Results: NEP was detected in 26 (29.5%) and NOP
was detected in 50 (56.8%) patients with LE. VAS at the initial visit, worst
VAS and average VAS scores during past 4 weeks were significant higher
in NEP group (p=0.003, p=0.006, p=0.004 respectively). Quick-DASH
score was 64.62 (55.06-75) in NEP and 45.12 (28.93-52.81) in NOP groups
(p<0.001). Positive correlations were found between VAS score at the initial
visit, worst VAS and average VAS scores during the past 4 weeks and
PDQ scores in NEP group (r=0.652 p<0.001, r=0.436 p=0.026, r=0.661
p<0.001 respectively). Quick-DASH score was found to be independent
prognostic factors for NEP (p=0.001). Conclusion: NEP may cause an increased
disability in patients with LE, therefore it is necessary to evaluate
NEP in these patients group.
Keywords: Lateral epicondylitis, neuropathic pain, disability
REFERENCES
- Ueda H. Systems pathology of neuropathic pain and fibromyalgia. Biol Pharm Bull. 2019;42:1773-82. [Crossref] [PubMed]
- Torrance N, Smith BH, Bennett MI, et al. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain. 2006;7:281-9. [Crossref] [PubMed]
- Bouhassira D, Lantéri-Minet M, Attal N, et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008;136:380-7. [Crossref] [PubMed]
- Bouhassira D. Neuropathic pain: definition, assessment and epidemiology. Rev Neurol (Paris). 2019;175:16-25. [Crossref] [PubMed]
- Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron. 2006;52:77-92. [Crossref] [PubMed] [PMC]
- Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2:1-8. [Crossref] [PubMed]
- Brummel J, Baker CL 3rd, Hopkins R, et al. Epicondylitis: lateral. Sports Med Arthrosc Rev. 2014;22:e1-6. [Crossref] [PubMed]
- Karasugi T, Ide J, Kitamura T, et al. Neuropathic pain in patients with rotator cuff tears. BMC Musculoskelet Disord. 2016;17:451. [Crossref] [PubMed] [PMC]
- Freynhagen R, Baron R, Gockel U, et al. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22:1911-20. [Crossref] [PubMed]
- Ohtori S, Orita S, Yamashita M, et al. Existence of a neuropathic pain component in patients with osteoarthritis of the knee. Yonsei Med J. 2012;53:801-5. [Crossref] [PubMed] [PMC]
- Gwilym SE, Oag HC, Tracey I, et al. Evidence that central sensitisation is present in patients with shoulder impingement syndrome and influences the outcome after surgery. J Bone Joint Surg Br. 2011;93:498-502. [Crossref] [PubMed]
- Price DD, McGrath PA, Rafii A, et al. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17:45-56. [Crossref] [PubMed]
- Price DD, Bush FM, Long S, et al. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994;56:217-26. [Crossref] [PubMed]
- Clement ND, Duckworth AD, Jenkins PJ, et al. Interpretation of the QuickDASH score after open carpal tunnel decompression: threshold values associated with patient satisfaction. J Hand Surg Eur Vol. 2016;41:624-31. [Crossref] [PubMed]
- Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44. [Crossref] [PubMed] [PMC]
- Haldorsen B, Svege I, Roe Y, et al. Reliability and validity of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire in patients with shoulder impingement syndrome. BMC Musculoskelet Disord. 2014;15:78. [Crossref] [PubMed] [PMC]
- Altan L, Ercan I, Konur S. Reliability and validity of Turkish version of the patient rated tennis elbow evaluation. Rheumatol Int. 2010;30:1049-54. [Crossref] [PubMed]
- Freynhagen R, Baron R. The evaluation of neuropathic components in low back pain. Curr Pain Headache Rep. 2009;13:185-90. [Crossref] [PubMed]
- Alkan H, Ardic F, Erdogan C, et al. Turkish version of the painDETECT questionnaire in the assessment of neuropathic pain: a validity and reliability study. Pain Med. 2013;14:1933-43. [Crossref] [PubMed]
- Ahmad Z, Siddiqui N, Malik SS, et al. Lateral epicondylitis: a review of pathology and management. Bone Joint J. 2013;95-B:1158-64. [Crossref] [PubMed]
- O'Connor TM, O'Connell J, O'Brien DI, et al. The role of substance P in inflammatory disease. J Cell Physiol. 2004;201:167-80. [Crossref] [PubMed]
- Quartara L, Maggi CA. The tachykinin NK1 receptor. Part II: distribution and pathophysiological roles. Neuropeptides. 1998;32:1-49. [Crossref] [PubMed]
- Pedersen-Bjergaard U, Nielsen LB, Jensen K, et al. Calcitonin gene-related peptide, neurokinin A and substance P: effects on nociception and neurogenic inflammation in human skin and temporal muscle. Peptides. 1991;12:333-7. [Crossref] [PubMed]
- McCarson KE. Central and peripheral expression of neurokinin-1 and neurokinin-3 receptor and substance P-encoding messenger RNAs: peripheral regulation during formalin-induced inflammation and lack of neurokinin receptor expression in primary afferent sensory neurons. Neuroscience. 1999;93:361-70. [Crossref] [PubMed]
- Peterson M, Svärdsudd K, Appel L, et al. PET-scan shows peripherally increased neurokinin 1 receptor availability in chronic tennis elbow: visualizing neurogenic inflammation? PLoS One. 2013;8:e75859. [Crossref] [PubMed] [PMC]
- Ko S, Choi C, Kim S, et al. Prevalence and risk factors of neuropathic pain in patients with a rotator cuff tear. Pain Physician. 2018;21:E173-E80. [Crossref] [PubMed]
- Polat CS, Doğan A, Sezgin Özcan D, et al. Is there a possible neuropathic pain component in knee osteoarthritis? Arch Rheumatol. 2017;32:333-8. [Crossref] [PubMed] [PMC]
