E. Rio1, M. Pazzinatto2,3, K. Crossley1, R. Johnston1, S. Coburn1, D. Jones1, A. Smith4, J. Kemp1
1La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Australia, 2La Trobe University, Physiotherapy, Bundoora, Australia, 3Sao Paulo State University (UNESP), Laboratory of Biomechanics and Motor Control, School of Science and Technology, Presidente Prudente, Brazil, 4Curtin University, Faculty of Health Sciences, Bentley, Australia
Background: Femoroacetabular impingement (FAI) syndrome is a common cause of hip pain associated with bony morphology, impacts activities of daily living and often progresses to surgery. Surgical failure rates, including revision or dissatisfaction are >20%. Improved understanding of the pain profile and potential prognostic stratified risk of poor outcome of people with FAI syndrome could tailor treatments.
Patient reported outcome measures that capture pain and function with predetermined activities are commonly used to describe symptom severity in people with hip pain. However, given the variability in response to current treatments (both conservative and surgical) we aimed to describe the presence of neuropathic symptoms and report baseline risk profile data that could be used to develop a stratified care model in people with FAI syndrome.
Patient reported outcome measures that capture pain and function with predetermined activities are commonly used to describe symptom severity in people with hip pain. However, given the variability in response to current treatments (both conservative and surgical) we aimed to describe the presence of neuropathic symptoms and report baseline risk profile data that could be used to develop a stratified care model in people with FAI syndrome.
Purpose: To describe the neuropathic pain profile and baseline risk factor profile in people with FAI syndrome.
Methods: Eligible participants met these criteria; 18-50 years, hip pain >6 weeks, >3/10 pain on impingement tests and radiographic FAI-alpha angle >60 degrees. Participants completed PainDETECT; a validated patient reported tool describing the presence of neuropathic symptoms (scores range from -1 to 38, -1 is the best possible score, >12 represents possible neuropathic pain and >18 positive neuropathic pain). Participants completed START MSK; a validated tool designed to screen for prognostic risk and tailor decision making (not yet been used in hip). Possible scores range 0-12; 0-4 low risk, 5-8 medium and 9-12 high risk of poor outcome. La Trobe University Human Ethics Committee (HEC 17-080) approved the study. Non-normally distributed data were reported as median and range.
Results: 150 participants (51% women, mean BMI 24.5±4.95) were included; in the preceding week average reported pain intensity was median 4 (range 1-9)/10 and worst pain 7 (1-10). Median painDETECT score was 8 (range 0-25). However, 38 participants (25%) recorded a score >12 and 5.3% > 18 points. 30% of participants recorded radiating pain and 41% reported persistent pain (either with pain fluctuations or pain attacks). Sensitivity to light touch and temperature was infrequently reported. Baseline START MSK scores (n=129) were median 6 (0-11) and total for items 5-9 was 4; 27.13% of participants were classified as low, 51.16% medium and 21.71% high risk.
Conclusion(s): At a group level, participants with FAI syndrome did not meet the diagnostic criteria for likely neuropathic pain. However, 5.3% of this cohort scored positive neuropathic and one quarter of the sample recorded scores indicating possible neuropathic pain. Based on the risk stratification tool for low back pain, START MSK scores indicate most are at medium or high risk of poor outcome, providing clear rationale for targeted education and management. As this is part of a prospective study, these data will assist with developing stratified scores specific to the hip to inform baseline decision making.
Implications: People with FAI should be screened for persistent pain and neuropathic symptoms as potential treatment modifiers; they may require different education and management to those without this profile. Baseline risk using START MSK tool may be able to stratify risk for people with hip pain.
Funding, acknowledgements: This study was funded by a National Health and Medical Research Council (Australia) Early Career Fellowship (Dr Kemp) GTN1117791.
Keywords: Hip, Pain, Neuropathic
Topic: Musculoskeletal: lower limb
Did this work require ethics approval? Yes
Institution: La Trobe University
Committee: La Trobe University
Ethics number: (HEC 17-080)
All authors, affiliations and abstracts have been published as submitted.
