Jeffrey A. Brown
  1. Neurological Surgery, P.C., 600 Northern Blvd #118, Great Neck, 11021, United States

Correspondence Address:
Jeffrey A. Brown
Neurological Surgery, P.C., 600 Northern Blvd #118, Great Neck, 11021, United States


Copyright: © 2018 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Brown JA. Commentary on: Neuropathic pain in low back-related leg pain patients: What is the evidence of prevalence, characteristics, and prognosis in primary care? A systematic review of the literature. Surg Neurol Int 08-Feb-2018;9:23

How to cite this URL: Brown JA. Commentary on: Neuropathic pain in low back-related leg pain patients: What is the evidence of prevalence, characteristics, and prognosis in primary care? A systematic review of the literature. Surg Neurol Int 08-Feb-2018;9:23. Available from:

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This intensively researched paper is a study of nearly 3000 patients initially evaluated at primary care centers for low back pain.[ 1 ] Some were diagnosed with a component of neuropathic leg pain and another group had what the authors consider to be nociceptive referred leg pain. Such patients had non-neuropathic pain in a leg in association with low back pain. The authors conclude that there is “some evidence of higher levels of morbidity in low back leg pain patients with neuropathic pain.” This is hardly earthshattering. Primary care providers if they find evidence of neuropathic leg pain should be aware that this is more serious than if there is nociceptive leg pain. However, there is no overarching statistic that the authors of this paper present to confirm this conclusion. “More research is needed” is hardly helpful. They state that there is “some consistent evidence for worse back and leg pain related disability in LBLP (low back leg pain) patients with neuropathic pain.” Such conclusions are consistent with other published evidence, but the authors sought to confirm this by studying only those patients who presented to primary care centers. For a study that relied heavily on careful collation of scientific studies, there is a paucity of statistical inclusion in the results.

This study excludes patients who were diagnosed with lumbar spinal stenosis and “herniated discs,” as well as patients with diabetes, malignancy, fractures, cauda equina symptoms, multiple sclerosis, Guillain–Barre syndrome, HIV disease, rheumatoid conditions, and spinal cord injury. What does this mean? The authors are left with a group of patients with back pain of unknown origin, which is presumably the most common reason that one would consult a primary care physician.

To be diagnosed with neuropathic pain, the authors note that there must be evidence of somatosensory injury. It is unclear what the mechanism for this would be, given the exclusion of a vast list of known reasons for it to occur, including the most common – spinal stenosis and herniated discs. What is also unclear is the mechanism for nociceptive or referred leg pain with low back pain.

Certainly patients frequently experience a mixture of nociceptive and neuropathic pain symptoms, with one form dominant over the other, but it is unclear what the cause of non-neuropathic, nociceptive “referred” leg pain would be. The authors reference an open access paper that defines it as pain that “does not involve compression of nerve roots but is rather explained by a convergent afferent input on central neurons.” Such a phrase comes under the heading of “mumbo jumbo.” The term has an interesting origin, of which its essence is that “mumbo jumbo” can be exceedingly convincing. It is not, however, scientifically so.

It is important to note that this paper is, by the authors’ admission, not a meta-analysis. Clearly, a great deal of effort was made to filter down the available “wealth” of information to the twelve acceptable studies. In the end, this paper reads like the preamble to a future systematic evaluation of the full nature of the pain present in individuals who present to primary care providers under the umbrella of “low back pain.”

This is certainly a worthwhile goal.


1. Harrisson SA, Stynes S, Dunn KM, Foster NE, Konstantinou K. Neuropathic Pain in Low Back-Related Leg Pain Patients: What Is the Evidence of Prevalence, Characteristics, and Prognosis in Primary Care?. A Systematic Review of the Literature. J Pain. 2017. 18: 1295-312


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    Kay Boucher

    Posted December 12, 2018, 4:28 pm

    I have a çurvature of the spine (stenosis????) & at 76 years of age it is really driving me crazy.
    Five years back I had a fall & fractured y left hip. It was a long painful ‘recovery'(if u could call it a recovery) followed by weeks in hospital rehab– then again months & still roctinualing of rehabilitation ( physiotherapy) I am still using a 4 legged walker thing which is a nuisance but the left hip ended up about 1 & a half inches shorter than the right. I did see my orthopedic surgeon about this to which he answered —”ahhh, well I guess a built up left footed shoe would do thee trick “—yes, I know does not sound like the brightest light in the chandelier. I have never had that done or even know of a place in Melbourne, Australia where I live that does that kind of thing. I have private health cover with Extras which would help with the costs. I know I am a bit old to be considering expensive measures to try & improve my quality of life, but I am not desperate for a $$$ & would like to give something a go. It still does pai me right up high on the lift buttock & I am on a continual does of strong pain relief — daily. I also suffer from peripheral neuropathy which turns both lower legs hot, burning hot — sp ,uch so I spend half my time with both feet o cold packs, it really does get unbearable. I do see my regular GP (& specialists regularly & everything else has been checked out). Would it be foolish at my age to seek some more quality life, I am not a sook but this is overbearing & been there for a number of years. Many thanks,
    KL Boucher. Victoria. AUSTRALIA
    email :


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