Neuropathic Pain in Patients with Sciatica: Prevalence and Related Factors.

Aim: To assess the prevalence of neuropathic pain (NP) in patients with sciatica and to determine the associated factors with increased incidence of neuropathic component in sciatica. Methods: A cross-sectional study enrolled 80 patients with sciatica from a rheumatology outpatient Hospital. Pain severity was measured us­ing the Visual Analogue Scale (VAS). The prevalence of NP was assessed according to the Douleur Neuropathique 4 (DN4). Statistical analysis was performed to find the factors closely related with NP. Results: A total of 70% of the participants were classified as having NP. The DN4 score≥4 was not significantly cor­related with VAS, but was significantly associated with gender (sex ratio=0.9; p=0,013), low educational level (p=0,008), illiteracy (p=0,012), chronic disease (p=0,019) and facet joint osteoarthritis (p=0,06). In multivariate logistic regression analysis, only chronicity of the disease remained an independent factor associated with NP in sciatica (OR=5,8). Conclusion: In the present study, NP was a major contributor to sciatica and the DN4 scale was a practical and rapidly administered screening tool for distinguishing the relative contributions of neuropathic component. The knowledge of the associated factors with NP in sciatica may improve the management of NP when these factors can be modified and targeted for treatment.

[Percutaneous vertebroplasty for pain relief in patients with osteoporotic spine fractures]

Percutaneous vertebroplasty [PVP] is an interventional radiology technique where pathological vertebral bodies are filled with acrylic cement. This method is used to strengthen the vertebral body and reduce pain in certain diseases involving the vertebrae such as osteoporosis. To evaluate PVP in symptomatic osteoporotic vertebral fractures after failure of conservative management. Between November 2008 to December 2009, PVP was performed for osteoporotic vertebral fractures in 12 consecutive patients in a single institution. Medium term [3 days and 15 days post PVP] and long term follow up [1 month and 3 months post PVP] consisted in the evaluation of residual or secondary pain using Huskisson's visual analogue scale. A total of 20 vertebrae were treated. Mean follow up was 80 days [30-90 days]. Significant symptomatic improvement [p=0.002] was noted with pre PVP pain score of 7.4 [ +/- 1.6], 3 days post PVP score of 4.1 [ +/- 2.1], 15 days post PVP score of 1.8 [ +/- 1.1], 1 month post PVP score of 1.22 [ +/- 1.06] and 3 months post PVP score of 1.4 [ +/- 1.14]. PVP appears to be an effective technique in the treatment of symptomatic osteoporotic vertebral fractures with approximately 94% of satisfactory results in the short and medium term period

[Procedural pain assessment after spinal injections of corticosteroid]

Spinal injections of corticosteroid are commonly performed by rheumatologists in their daily practice but little is known about the frequency, the intensity and the management of procedural pain observed in these osteoarticular injections in daily practice. To evaluate the prevalence and intensity of pain caused by spinal injections. In this observational prospective study, data were collected over 6 months, for up to 44 procedures [corticosteroid spinal injection]. Evaluation of the pain was evaluated immediately before and after the injection using Huskisson's visual analogue scale [VAS]. Statistical analysis was carried out in order to compare patients who had suffered from pain whilst undergoing the procedure to those who had not. Data were analyzed for 17 patients [12 female, mean age 53.6 +/- 10.5 years]. Over 50% of patients experienced procedural pain. Significant predictive factors of genesis of the procedural pain were the young age [p=0.022] and the intensity of the initial pain [p < 0.001], while the existence of a co morbidity is rather a protective factor [p = 0.006]. Others factors such us sex, origin, level of studies, socioeconomic conditions, didn't seem to have of effect on the procedural pain. Most patients undergoing spinal injections suffer from procedural pain. Specific research and guidelines for the management of procedural pain related to rheumatologic care should be established to improve the quality of care provided by physicians