CNS Update: Direct and Indirect Pathways for HRQOL Change from Pain Improvement in NeP Patients with Spine Diseases


eMediNexus    10 December 2022

Chronic low back pain or chronic cervical pain frequently holds a neuropathic pain (NeP) component and patients with these conditions complain of sleep deprivation, loss of physical function, and decreased productivity due to pain. A recent study clarified the pathway by which pain, sleep disturbance due to pain, and physical function status impact QOL measures in chronic low back pain patients with NeP associated with lumbar spine diseases (CLBP-NeP) and in chronic cervical pain patients with NeP associated with cervical spine diseases (CCP-NeP).


A model assuming pain numeric rating scale (NRS), pain-related sleep interference scale (PRSIS), and functional indices (Roland Morris Disability Questionnaire [RMDQ], Neck Disability index [NDI]) as factors affecting outcomes like QOL (calculated using EuroQoL 5 Dimensions (EQ-5D)), the Patient Global Impression of Change (PGIC), and the Clinical Global Impression of Change (CGIC) was designed using structural equation modelling.


The results showed the frequent presence of Overall trends in both patients with CLBP-NeP and CCP-NeP. Pain NRS showed the biggest comprehensive direct impact on QOL based on EQ-5D and an overall impression of varying symptoms. The effects of pain NRS on each outcome were found mostly due to direct pain-related effects; however, for EQ-5D, an indirect effect via functional improvement was found to be the primary factor.


Although the outcomes indicate that the indirect functional progress of pain relief may not be identified as a noteworthy element of therapeutic effects by both physicians and patients, the pain-relieving intervention donates directly to the gain of patients’ overall QOL and also indirectly via functional improvement. 

Therefore, to acquire the therapeutic goal for patients with NeP and minimize the impact of pain burden, pain relief interventions are vital from the perspective of the patient’s Health-Related Quality of Life (HRQOL).


Source: J Pain Res. 2021 Jun 1;14:1543-1551. doi: 10.2147/JPR.S289396. PMID: 34103979; PMCID: PMC8179792.

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