Sema HALİLOĞLU, AFİTAP İÇAĞASIOĞLU, Ayşe ÇARLIOĞLU, Nihal IŞIK

Kronik Bel ağrısının nöropatik komponenti

Amaç: Kronik bel ağrılı hastalarda nöropatik ağrı sıklı- ğını, ilişkili özellikleri, depresyon ve fiziksel disabilite ile ilişkisini belirlemek. Materyal ve Metot: Çalışmaya Erzurum Bölge Eğitim ve Araştırma Hastanesi Fizik Tedavi ve Rehabilitasyon Polikliniğine başvuran 108 kronik bel ağrılı hasta alındı. Hastalar sosyodemografik özellikleri içeren bir form ce- vaplandırdı. Nöropatik ağrı, depresyon, fiziksel disabilite değerlendirilmesi için sırasıyla Neuropathic pain diagnostic questionnaire (DN4), Beck Depression Envanteri (BDE) ve Roland-Morris Disabilite (RMD) soru formları kulla- nıldı. Bulgular: Hastaların yaş ortalaması 44,46±13,94 idi. Hastaların 42sinde (%38,9) nöropatik ağrı komponenti mevcuttu. Nöropatik ağrı ile vücut-kitle indexi (VKø) arasında pozitif korelasyon saptandı (p=0,013; r=0,237). Kadınlarda nöropatik ağrı komponenti varlığı erkeklere oranla istatistiksel olarak anlamlı derecede yüksekti (p=0,003). Fiziksel disabilite arttıkça nöropatik ağrı varlığının da arttığı tespit edildi (p=0,001). Depresyon ile nöropatik ağrı arasında da pozitif korelasyon mevcuttu (p=0,001; r=0,398). Kadınlardaki depresyon oranı er- keklere göre istatistiksel olarak anlamlı derecede yük- sekti (p=0,007). Fiziksel disabilite ve depresyon arasında da pozitif ilişki mevcuttu (p=0,001). Sonuçlar: Bel ağrılarının akut döneminde daha çok nosiseseptif ağrı hakimdir. Fakat ilerleyen dönemde özellikle nosiseptif ağrının kontrolü yeterince sağlana- mazsa ağrı kronikleşebilir ve nöropatik ağrı komponenti baskın hale gelebilir. Kronik bel ağrısına yaklaşımda nöropatik ağrı komponentinin de göz önünde bulun- durulması tedavide başarıyı arttıracaktır.

(The neuropathic component of chronic low back pain)

ABSTRACT Background: The aims of this study were to determine the frequency of neuropathic pain with chronic low back pain, factors related to neuropathic pain, the relationship between the depression and physical disability. Material and Methods: One hundred eight patients with chronic low back pain who came to Erzurum Region Education and Research Hospital, out-patient clinic of Physical Medicine and Rehabilitation Department were included in the study. Patients answered questions in forms that include sociodemographic properties of them. Neuropathic pain diagnostic questionnaire (DN4), Beck Depression Inventory (BDI) and Roland-Morris Disability (RMD) questionnaires were used to assess the neuropathic pain, the depression, and the physical disability, respectively. Results: The average age of patients was 44,46±13,94 years. Forty two patients (%38,9) had a neuropathic pain component. Neuropathic pain and body-mass index (BMI) were positively correlated (p=0,013; r=0,237). In women, the presence of neuropathic pain component was significantly higher than men (p = 0.003). Also, the presence of neuropathic pain was found to increase with higher physical disability (p=0,001). There was a positive correlation between depression and neuropathic pain (p=0,001; r=0,398). The rate of depression in women compared to men was significantly high (p= 0,007). There was a positive correlation between disability and depression (p=0,001). Conclusions: Usually, nociceptive pain is dominant in the acute phase of low back pain. If it is unable to adequately control the nociceptive pain, pain may become chronic and neuropathic pain can become dominant component. Management of chronic low back pain, consideration of neuropathic pain component will increase the success of treatment.

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