Oral Presentation Sydney Spinal Symposium 2025

Nociceptive pain assessed by the PainDETECT questionnaire may predict response to opioid treatment for chronic low back pain. (124553)

Stone Sima 1 , Sam Lapkin 2 , Zachary Gan 1 , Victor Chen 1 , Ashish Diwan 1 3 4
  1. Spine Labs, St George and Sutherland Clinical School, Sydney, NSW, Australia
  2. Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
  3. Spine Service at St George and Sutherland Clinical School, Sydney, NSW, Australia
  4. Spinal Unit, Discipline of Orthopaedic Surgery, School of Medicine, University of Adelaide, Adelaide, Australia

Introduction: The pharmacological management of chronic low back pain (LBP) is complex. The WHO recommends a laddered approach to pain medication usage. The PainDETECT questionnaire distinguishes between neuropathic pain (NeP), nociceptive pain (NoP), and ambiguous pain. By elucidating the difference in medication efficacy between these groups, clinicians can provide a tailored treatment plan to manage patient’s pain. This study aimed to investigate the relationship between pharmacological treatments, pain categorizations, and medication efficacy as reported by patients.

Methods: A secondary retrospective analysis of a prospectively collected database was conducted involving 318 consecutively recruited adult patients. Medication history was categorised into four lines of treatment: first line (paracetamol non-prescribed anti-inflammatories), second line (prescribed anti-inflammatories), third line (anticonvulsants/neuromodulators) and fourth line (opioids). Medication efficacy was measured using a three-point Likert scale: effective (+2), somewhat effective (+1), no effect (0).

Findings: The study included 120, 50, 54 and 94 patients on first line, second line, third line and fourth line treatment, respectively. The NeP group had higher NRS compared to NoP group in all four lines of treatment. When confounding for severity of LBP as measured by NRS, the distribution of medication efficacy significantly differed amongst the NeP, ambiguous and NoP groups in patients undergoing fourth line pharmacological treatment (r2=8.623, p<0.05). The NoP group exhibited significantly higher medication efficacy compared to the NeP group (U=14.038, p<0.05). There was no significant difference in medication efficacy across the pain classifications for first, second- and third-line treatment.

Interpretation: Opioids was the only line of treatment more effective in targeting NoP, as determined by the PainDETECT questionnaire, compared to NeP. This pioneering study illustrates the complex nature of pharmacological management for chronic LBP. It underscores the importance of tailoring pharmacological treatment plans to fit individual pain profiles and expectations instead of adopting a blanket approach to pain management.