manuelletherapie 2013; 17(03): 127-135
DOI: 10.1055/s-0033-1351110
Originalia
Literaturstudie
Georg Thieme Verlag KG Stuttgart · New York

Unterscheidungsmerkmale somatisch bedingter Übertragungs- versus neuropathischer Schmerzen bei Rückenschmerzpatienten mit oder ohne ausstrahlende Beinschmerzen[1]

Systematischer LiteraturreviewDistinguishing Features of Somatic-Induced Referred Pain versus Neuropathic Pain in Back Pain Patients with or without Radiating Leg PainSystematic Literature Review
Stefan Mair
1   Sporttherapie & Training Sporttherapie Mag. Huber GmbH, Steinbockallee 31, 6063 Neu-Rum, Österreich
,
R Schesser
,
F Morrsion
› Author Affiliations
Further Information

Publication History

Publication Date:
22 July 2013 (online)

Zusammenfassung

Low back pain (LBP) ist ein weitverbreitetes Beschwerdebild, das häufig mit Ausstrahlungen ins Bein einhergeht. Für derartige Beinschmerzen können direkt vom Nervensystem verursachte (neuropathische) bzw. fortgeleitete Schmerzen aus somatischen lumbalen Strukturen (Referred pain) verantwortlich sein. Das Erkennen der jeweiligen Schmerzursache ist essenziell für die entsprechende Behandlungsstrategie.

Ziel dieses Systematic Reviews war es, die Literatur hinsichtlich Unterscheidungsmerkmalen der klinischen Präsentation zwischen „somatisch Referred Pain bedingten“ und „neuropathisch bedingten“ Rückenschmerzen mit oder ohne Ausstrahlung ins Bein zu analysieren. Anhand der Unterscheidungsmerkmale „Schmerzqualität“ und „physische Funktionsuntersuchung“ kann zwischen somatisch Referred Pain bedingten und neuropathisch bedingten Rückenschmerzen unterschieden werden, anhand der „Schmerzausbreitung“ ist keine Differenzierung möglich.

Abstract

Low back pain is a prevalent clinical presentation, which often coincides with radiating leg pain. Nervous system related (neuropathic) or transferred pain from somatic lumbar structures (referred pain) may be responsible for this leg pain. Identification of the particular pain source is essential for the relevant treatment strategy.

The aim of this systematic review was to analyse the literature with a view towards the distinguishing features of the clinical presentation of “somatic referred pain related” and “neuropathic related” back pain with or without radiating leg pain. The distinguishing features “pain quality” and “physical function assessment” can differentiate between somatic referred pain related and neuropathic related back pain, on the basis of “pain distribution” differentiation is not possible.

Anmerkung

1 Die Arbeit wurde im Rahmen der OMT-Ausbildung 2010–2013 des 3. Moduls „Schmerzwissenschaft“ erstellt.


 
  • Literatur

  • 1 Andersson G. Epidemiological features of chronic low back pain. Lancet 1999; 354: 581-585
  • 2 Arendt-Nielsen L, Svensson P. Referred Muscle Pain: Basic and Clinical Findings. The Clinical Journal of Pain 2001; 17: 11-19
  • 3 Audette JF, Emenike E, Meleger AL et al. Neuropathic low back pain. Current pain and headache reports 2005; 9: 168-177
  • 4 Beith ID, Kemp A, Kenyon J et al. Identifying neuropathic pain and leg pain: A cross-sectional study. Pain 2011; 152: 1511-1516
  • 5 Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain 2009; 147: 17-19
  • 6 Brisby H. Pathology and Possible Mechanisms of Nervous System Response to Disc Degeneration. The Journal of Bone and Joint Surgery 2006; 88A: 68-71
  • 7 Buijs E, Visser L, Groen G. Sciatica and the sacroiliac joint: a forgotten concept. British Journal of Anaesthesia 2007; 99: 713-716
  • 8 Crombie IK. The pocket guide to critical appraise: a handbook for health care professionals. London: BMJ Publishing Group; 2011
  • 9 Deyle GD. Musculoskeletal Imaging in Physical Therapist Practice. Journal of Orthopaedic & Sports Physical Therapy 2005; 35: 708-721
  • 10 Dworkin RH, Jensen MP, Gammaitoni AR et al. Symptom Profiles Differ in Patients with Neuropathic versus Non-neuropathic Pain. The Journal of Pai 2007; 8: 118-126
  • 11 Frey Law LA, Sluka KA, Mc Mullen T et al. Acidic buffer induced muscle pain evokes referred pain and mechanical hyperalgesia in humans. Pain 2008; 140: 254-264
  • 12 Giamberardino MA. Referred Muscle Pain/Hyperalgesia and Sensitisation. Journal of Rehabilitation Medicine 2003; (Suppl. 41) 85-88
  • 13 Gifford L. Schmerzphysiologie. In: Van den Berg F, Hrsg. Angewandte Physiologie. II: Organsysteme verstehen und beeinflussen. Stuttgart: Thieme; 2005
  • 14 Govind J. Lumbar radicular pain. Australian Family Physician 2004; 33: 409-412
  • 15 Greenhalgh T. How to read a paper: the basics of evidence-based medicine. London: Wiley-Blackwell; 2010
  • 16 Herbert R. Quality Issues Reading Clinical Research Papers: Introduction. APA NSW Bulletin 1997; 34
  • 17 Jung JH, Kim HI, Shin DG et al. Usefulness of Pain Distribution Pattern Assessment in Decision-Making for the Patients with Lumbar Zygapopyseal and Sacroiliaca Joint Arthropathy. J Korean Med Sci 2007; 22: 1048-1054
  • 18 Karnath B. Clinical Signs of Low Back Pain. Hospital Physician 2003; 5: 39-44
  • 19 Kidd BL, Richardson PM. How does neuropathophysiology affect the signs and symptoms of spinal disease?. Best Practice & Research Clinical Rheumatology 2002; 16: 31-42
  • 20 Koes B, van Tulder M, Thomas S. Diagnosis and treatment of low back pain. Br Med J 2006; 332: 1430-1434
  • 21 Machacek P, Friedrich M. Schmerztopik bei lumbalen Bandscheibenschäden. Z Orthop 2006; 144: 19-26
  • 22 Masters S, Lind R. Musculoskeletal pain – presentation to general practice. Australian Family Physician 2010; 39: 425-428
  • 23 Mersky H, Bogduk N. eds. Classification of chronic pain. Descriptions of chronic pain syndromes and definition of pain terms. Seattle: IASP; 1994
  • 24 Murphy DR, Hurwitz EL, Gerrard JK et al. Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?. Chiropractic & Osteopathy 2009; 17: 1-9
  • 25 O‘ Hearn M, Lowry C, Emerson-Kavchak A Re: Schäfer A, Hall TM, Lüdtke K et al. Interrater reliability of a new classification scheme for patients with neural low back-related leg pain (J Man Manip Ther 2009; 17: 109-116). The Journal of Manual & Manipulative Therapy 2009; 17: E115-E116
  • 26 O’Neill CW, Kurgansky ME, Derby R et al. Disc Stimulation and Patterns of Referred Pain. Spine 2002; 27: 2776-2781
  • 27 O’Neill S, Graven-Nielsen T, Manniche C et al. Ultrasound-guided, painful electrical stimulation of lumbar facet joint structures: An experimental model of acute low back pain. Pain 2009; 144: 76-83
  • 28 Ohtori S, Takahashi K, Chiba T et al. Calcitonin gene-related peptide immunoreactive neurons with dichotomizing axons projecting to the lumbar muscle and knee in rats. European Spine Journal 2003; 12: 576-580
  • 29 Robinson JR. Lower Extremity Pain of Lumbar Spine Origin: Differentiating Somatic Referred and Radicular Pain. The Journal of Manual & Manipulative Therapy 2003; 11: 223-234
  • 30 Robinson ES, Lindley EM, Gonzalez P et al. Piriformis Syndrome versus Radiculopathy Following Lumbar Artificial Disc Replacement. Spine 2011; 36: E282-E287
  • 31 Schäfer A, Hall T, Briffa K et al. Classification of low back-related leg pain – A proposed pathomechanism-based approach. Manual Therapy 2009; 14: 222-230
  • 32 Schäfer A, Hall T, Lüdtke K et al. Interrater Reliability of a New Classification System for Patients with Neural-Related Leg Pain. The Journal of Manual & Manipulative Therapy 2009; 17: 109-117
  • 33 Schesser R. What is the Evidence for the Management of Cervical Radiculopathy? [Master-Thesis]. Adelaide: University of South Australia; 2000
  • 34 Selim AJ, Ren XS, Fincke G et al. The Importance of Radiating Leg Pain in Assessing Health Outcomes among Patients with Low Back Pain: Results from the Veterans Health Study. Spine 1998; 23: 470-474
  • 35 Slipman CW, Patel RK, Whyte WS et al. Diagnosing and managing sacroiliacal pain. The Journal of Musculoskelettal Medicine 2001; 6: 325-332
  • 36 Valat J-P, Genevay S, Marty M et al. Sciatica. Best Practice & Research Clinical Rheumatology 2010; 24: 241-252
  • 37 Vranken JH. Mechanisms and Treatment of Neuropathic Pain. Central Nervous System Agents in Medicinal Chemistry 2009; 9: 71-78
  • 38 Walsh J, Hall T. Reliability, validity and diagnostic accuracy of palpation of the sciatic, tibial and common peroneal nerves in the examination of lo back related leg pain. Manual Therapy 2009; 14: 623-629
  • 39 Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanism, and management. The Lancet 1999; 353: 1959-1964
  • 40 Van der Wurff P, Bujis EJ, Groen GJ. Intensity Mapping of Pain Referral Areas in Sacroiliac Joint Patients. J Manipulative Physiol Ther 2006; 29: 190-195