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Predicting the outcome of persistent sciatica using conditioned pain modulation: 1-year results from a prospective cohort study.
Fjeld, Olaf R; Grotle, Margreth; Matre, Dagfinn; Pedersen, Linda M; Lie, Marie U; Småstuen, Milada C; Storheim, Kjersti; Heuch, Ingrid; Stubhaug, Audun; Zwart, John-Anker; Nilsen, Kristian Bernhard.
Afiliación
  • Fjeld OR; Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Oslo, Norway.
  • Grotle M; Department of Neurology, Oslo University Hospital, Oslo, Norway.
  • Matre D; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
  • Pedersen LM; Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Oslo, Norway.
  • Lie MU; Faculty of Health Science, OsloMet - Oslo Metropolitan University, Oslo, Norway.
  • Småstuen MC; Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway.
  • Storheim K; Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Oslo, Norway.
  • Heuch I; Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Oslo, Norway.
  • Stubhaug A; Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Oslo, Norway.
  • Zwart JA; Institute of Physiotherapy, Faculty of Health Science, Oslo and Akershus University College, Oslo, Norway.
  • Nilsen KB; Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Oslo, Norway.
Scand J Pain ; 20(1): 69-75, 2019 12 18.
Article en En | MEDLINE | ID: mdl-31527299
ABSTRACT
Background and aims Recovery in patients hospitalised with severe sciatica is unpredictable. Prognostic tools to aid clinicians in the early identification of patients at risk of developing chronic sciatic pain are warranted. Conditioned pain modulation (CPM) is a psychophysical measure of the endogenous pain modulatory pathways. Several studies have suggested CPM as a potentially important predictive biomarker for the development of chronic pain. The aim of the study was to determine whether CPM effect in patients still suffering from leg pain 6 weeks after hospital discharge for severe sciatica is associated with persistent leg pain at 12 months. A potential association would suggest that measuring CPM effect could be a valuable prognostic tool in the hospital management of sciatica. Methods A prospective cohort study in which CPM effect was measured 6 weeks after hospital discharge following an acute admission with sciatica as the main complaint. The impact of CPM effect on the outcome was analysed using logistic regression. The outcome measured was self-reported leg pain score of ≥1 in the past week on a 0-10 numeric rating scale (NRS) at 12 months post discharge. Results A total of 111 patients completed the entire study, 51 of whom received non-randomised surgical treatment. Crude and confounder adjusted analyses showed no significant association between CPM effect and leg-pain measured at 12 months, crude Odds Ratio 0.87, 95% CI 0.7-1.1, p = 0.23. Conclusions Our results suggest that CPM assessment has limited prognostic value for the long-term outcome in severe sciatica when measured 6 weeks after hospital discharge. Implications The present study adds important knowledge concerning the limited clinical use of late CPM testing in sciatica patients. The heterogeneity in patients, the wide range of treatments received and a generally favourable outcome are factors that may affect CPM's clinical value as a prognostic factor for severe sciatica.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Dolor / Pronóstico / Ciática / Dimensión del Dolor Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Scand J Pain Año: 2019 Tipo del documento: Article País de afiliación: Noruega

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Dolor / Pronóstico / Ciática / Dimensión del Dolor Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Scand J Pain Año: 2019 Tipo del documento: Article País de afiliación: Noruega