Rded as clinically relevant in the entire Fexinidazole custom synthesis population (column “total”). A symptom was considered clinically relevant if the patient marked a score of .3 (strongly or very strongly). The most prominent symptoms were pain attacks and pressure induced pain described as clinically relevant in 27 and 22.8 . Clinically relevant touch evoked allodynia (5.6 ) and thermal induced pain (5.6 ) as well as numbness (4.9 ) were uncommon symptoms. Of all patients 12.1 3PO web scored positive on the PD-Q (i.e. neuropathic elements likely, n = 131), while 69.3 scored negative (i.e. neuropathic elements unlikely, n = 750) and 18.7 unclear (n = 202) (Table 1, figure 1 “total”).Sleep disturbance Optimal sleep Somnolence Sleep quantity (hours) Sleep adequacy 6.40.3 43.9 37.51.BMI: Body mass index; 24195657 PD-Q: painDETECT questionnaire; IVD: intervertebral disc; PHQ-9: nine item scale of Patient Health Questionnaire; MOS-SS: Medical Outcome Study sleep scale; * mean 6 standard deviation. doi:10.1371/journal.pone.0068273.tSubgroups of Patients Based on Sensory AbnormalitiesA cluster analysis was performed to identify relevant subgroups which present with a characteristic constellation of sensory symptoms. Figure 2A shows the different clusters with distinctsymptom profiles and table 2 their corresponding frequencies. In the five-cluster-solution we found sensory profiles with remarkable differences in the expression of the experienced symptoms. All subgroups represented a relevant part of the cohort (14?6 ). Cluster 1 (n = 237, 21 ) and cluster 2 (n = 229, 21 ) demonstrate only one dominating symptom, i.e. painful attacks or pressure induced pain, respectively. In cluster 4 (n = 175, 16 ) pressure-induced pain and burning sensations were prominent whereas nearly all other symptoms were moderately expressed. Cluster 3 (n = 162, 14 ) is characterized by relevant prickling and burning sensations. The profile of cluster 5 (n = 280, 26 ) is mainly concentrated around the zero-line for all parameters. This indicates that the patients tend to mark a similar score for all questions. Although the average pain intensity was VAS 4.9 in this group all sensory symptoms were only rated in the range of “never” to “hardly noticed” (see non-adjusted profile, figure 2B).Sensory Profiles in Axial Low Back PainTable 2. Pain and perceived sensory symptoms in patients with axial low back pain.IVD-surgeryOf the patients with axial low back pain without IVD-surgery 70.3 scored negative in the PD-Q (n = 650), while 11.6 scored positive (n = 107). Post-IVD-surgery patients were negative in 63.3 (n = 100) and positive in 15.2 (n = 24, Figure 3). The frequency of score values between the surgery and non-surgery groups failed to be significant (x2-Test, p = 0.2215). An analysis of the different clusters was not performed because of low patient numbers within the corresponding subgroups.total n VAS (worst)* VAS (average)* VAS (current)* 1083 7.262.2 5.462.2 4.762.Cluster 1Cluster 2Cluster 3Cluster 4Cluster 5 237 7.662.2 5.362.3 4.662.7 229 7.162.2 5.362.2 4.762.5 162 6.962.3 5.562.2 5.162.4 175 7.761.9 5.961.9 5.462.5 280 6.762.3 4.962.3 4.362.Clinical relevant complaint ( ) ** Burning Prickling Allodynia Attacks Thermal Numbness Pressure 16.2 10.9 5.6 27.0 5.6 4.9 22.8 1.7 2.5 0.4 75.1 3.4 0.8 20.7 1.3 3.1 7.9 3.9 3.9 1.3 42.8 25.9 36.4 3.1 21.0 2.5 21.0 8.6 56.6 11.4 8.6 27.4 1.1 0.0 33.7 9.6 9.3 7.9 8.2 13.6 5.0 9.DiscussionThe study revealed three main findings: (1) Neuropathic pain c.Rded as clinically relevant in the entire population (column “total”). A symptom was considered clinically relevant if the patient marked a score of .3 (strongly or very strongly). The most prominent symptoms were pain attacks and pressure induced pain described as clinically relevant in 27 and 22.8 . Clinically relevant touch evoked allodynia (5.6 ) and thermal induced pain (5.6 ) as well as numbness (4.9 ) were uncommon symptoms. Of all patients 12.1 scored positive on the PD-Q (i.e. neuropathic elements likely, n = 131), while 69.3 scored negative (i.e. neuropathic elements unlikely, n = 750) and 18.7 unclear (n = 202) (Table 1, figure 1 “total”).Sleep disturbance Optimal sleep Somnolence Sleep quantity (hours) Sleep adequacy 6.40.3 43.9 37.51.BMI: Body mass index; 24195657 PD-Q: painDETECT questionnaire; IVD: intervertebral disc; PHQ-9: nine item scale of Patient Health Questionnaire; MOS-SS: Medical Outcome Study sleep scale; * mean 6 standard deviation. doi:10.1371/journal.pone.0068273.tSubgroups of Patients Based on Sensory AbnormalitiesA cluster analysis was performed to identify relevant subgroups which present with a characteristic constellation of sensory symptoms. Figure 2A shows the different clusters with distinctsymptom profiles and table 2 their corresponding frequencies. In the five-cluster-solution we found sensory profiles with remarkable differences in the expression of the experienced symptoms. All subgroups represented a relevant part of the cohort (14?6 ). Cluster 1 (n = 237, 21 ) and cluster 2 (n = 229, 21 ) demonstrate only one dominating symptom, i.e. painful attacks or pressure induced pain, respectively. In cluster 4 (n = 175, 16 ) pressure-induced pain and burning sensations were prominent whereas nearly all other symptoms were moderately expressed. Cluster 3 (n = 162, 14 ) is characterized by relevant prickling and burning sensations. The profile of cluster 5 (n = 280, 26 ) is mainly concentrated around the zero-line for all parameters. This indicates that the patients tend to mark a similar score for all questions. Although the average pain intensity was VAS 4.9 in this group all sensory symptoms were only rated in the range of “never” to “hardly noticed” (see non-adjusted profile, figure 2B).Sensory Profiles in Axial Low Back PainTable 2. Pain and perceived sensory symptoms in patients with axial low back pain.IVD-surgeryOf the patients with axial low back pain without IVD-surgery 70.3 scored negative in the PD-Q (n = 650), while 11.6 scored positive (n = 107). Post-IVD-surgery patients were negative in 63.3 (n = 100) and positive in 15.2 (n = 24, Figure 3). The frequency of score values between the surgery and non-surgery groups failed to be significant (x2-Test, p = 0.2215). An analysis of the different clusters was not performed because of low patient numbers within the corresponding subgroups.total n VAS (worst)* VAS (average)* VAS (current)* 1083 7.262.2 5.462.2 4.762.Cluster 1Cluster 2Cluster 3Cluster 4Cluster 5 237 7.662.2 5.362.3 4.662.7 229 7.162.2 5.362.2 4.762.5 162 6.962.3 5.562.2 5.162.4 175 7.761.9 5.961.9 5.462.5 280 6.762.3 4.962.3 4.362.Clinical relevant complaint ( ) ** Burning Prickling Allodynia Attacks Thermal Numbness Pressure 16.2 10.9 5.6 27.0 5.6 4.9 22.8 1.7 2.5 0.4 75.1 3.4 0.8 20.7 1.3 3.1 7.9 3.9 3.9 1.3 42.8 25.9 36.4 3.1 21.0 2.5 21.0 8.6 56.6 11.4 8.6 27.4 1.1 0.0 33.7 9.6 9.3 7.9 8.2 13.6 5.0 9.DiscussionThe study revealed three main findings: (1) Neuropathic pain c.
