Clinical classification criteria for radicular pain caused by lumbar disc herniation: the radicular pain caused by disc herniation (RAPIDH) criteria

Abstract Context Classification criteria are recommended for diseases that lack specific biomarkers in order to improve homogeneity in clinical research studies. Since imaging evidence of lumbar disc herniations (LDH) may not be associated with symptoms, clinical classification criteria based upon patient symptoms and physical examination findings are required. Purpose This study aimed to produce clinical classification criteria to identify patients with radicular pain caused by LDH. Study Design Two stage process. Phase 1: Delphi process; Phase 2 cohort study. Patient sample Outpatients recruited from spine clinics in 5 countries Outcome Measures Items from history and physical examination Methods In Phase 1: Seventeen spine experts participated in a Delphi process to select symptoms and signs suggesting radicular pain caused by LDH. In Phase 2: Nineteen different clinical experts identified patients they confidently classified as presenting with: 1) Radicular pain caused by LDH, 2) neurogenic claudication (NC) caused by lumbar spinal stenosis (LSS), or 3) non-specific low back pain (NSLBP) with referred leg pain. Patients completed survey items and specialists documented examination signs. A score to predict radicular pain caused by LDH was developed based on the coefficients of the multivariate model. An unrestricted grant of less than 15000 USD was received from MSD: It was used to support the conception of the Delphi, data management and statistical analysis. No fees were allocated to participating spine specialists. Results Phase 1 generated a final list of 74 potential symptoms and signs. In phase 2, 209 patients with pain caused by LDH (89), neurogenic claudication (63), or NSLBP (57) were included. Items predicting radicular pain caused by LDH (p Conclusion Classification criteria for identifying patients with radicular pain caused by LDH are proposed. Their use could improve the homogeneity of patients enrolled in clinical research studies.