DUBAI, United Arab Emirates, June 6: The first-ever study in to the prevalence of nerve pain in adults suffering from chronic low-back pain in the Gulf has revealed that neuropathic pain is present in 55 percent of all cases of the condition  – making it more common than nociceptive pain.
The study carried out in the UAE, Bahrain, Oman, Qatar and Kuwait included 1,134 people who had suffered with back pain for more than three months, and whose pain was assessed using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale during their routine outpatients’ appointment.

Neuropathic
Results show that neuropathic pain was present in more than half (55.4 percent) of the study’s participants with the remainder suffering from nociceptive pain alone – making nerve pain the major contributor to chronic low-back pain which affects between six to 15 percent of adult populations.
“Chronic lower back pain is the third most common reason for people to seek outpatient medical care, and is associated with high levels of disability that impact heavily on rates of sick leave, visits to primary care centres, hospitalizations and the need for surgery. That is why this piece of research, which is the first to look the prevalence of nerve pain among those who suffer from chronic low-back pain in the Arabian Gulf, is so significant,” said Dr Waguih El Sissi, Head of Orthopaedics, Sheikh Kahlifa Hospital, Ajman. 
“Determining the prevalence of the nerve pain component of low-back pain is important because it is essential for choosing the most effective treatment options for patients, and for determining the healthcare costs associated with the condition as the costs of caring for those with nerve pain is 70 percent higher than for those with nociceptive pain,” he continued. Further results show, however, that only 11.4 percent of the patients in the study with nerve pain were receiving the correct treatment – leading the authors to call for all doctors managing low- back pain to screen patients for neuropathic pain using the LANSS test to ensure appropriate treatment.   
“The study shows that neuropathic pain is a major contributor to chronic lower back pain in the region which means it is essential that doctors are diagnosing the condition correctly. We advise using the LANSS Pain Scale test, which is practical and easy to use, and will enable physicians to initiate the best treatment straight away, ensuring that patients are receiving the best care,” concluded Dr El Sissi, one of the studyís authors.   
   
Causes
Rates of neuropathic pain were highest in patients with a diagnosis of disc prolapse (65.2 percent) and spinal canal stenosis (62.6 percent), occurring alone or with other causes of low- back pain. Neuropathic pain was also significantly more common among older patients, females, those with diabetes and patients who had a history of previous medical treatment.
Study participants who were found to have neuropathic pain had their treatment plans adjusted to include drugs such as pregabalin, gabapentin, nortriptyline and despipramine – all of which are recommended under international guidelines as first line treatments for peripheral neuropathic pain.
The research study was funded by Pfizer as part its commitment to supporting locally-based research that can inform medical management and improve patient outcomes.  
“Pfizer is committed to supporting local research studies that aim to better understand the manifestation of medical conditions among local populations, which can then be used to inform and improve disease management and ultimately patient care. The topic of neuropathic pain in chronic low-back pain is important in terms of setting up effective treatment plans and developing cost-effective healthcare services, and we look forward to supporting future studies in this area,” said Dr Yasser El Dershaby, Medical Director for Pfizer, Gulf.

Malfunction
Neuropathic pain is caused by damage to, malfunction of, or pathology affecting the either the peripheral nervous system or the central nervous system — originating in brain or spinal cord. Peripheral neuropathic pain is often described as burning, tingling, electrical, stabbing or pins and needles.
Nociceptive pain is initiated by stimulation of peripheral nerve fibres that respond only to stimuli approaching or exceeding harmful intensity and may be classified according to the mode of noxious stimulation; the most common categories being thermal (hot or cold), mechanical; crushing or tearing, and chemical such as chili powder in the eyes.