Comparison of Pain Intensity and Neuropathic Characteristics in Single-Level L4-L5 and L5-S1 Lumbar Disc Herniations

Introduction: Lumbar disc herniation is a common clinical condition in which pain severity and characteristics may differ according to the anatomical level involved. This study aimed to compare pain intensity and neuropathic pain features between patients with single-level L4-L5 and L5-S1 disc herniations.Methods: This cross-sectional observational study included 72 patients aged 18–80 years with MRI-confirmed single-level L4-L5 (n=46) or L5-S1 (n=26) herniations. Demographic and clinical data were recorded. Pain intensity was measured using the Visual Analog Scale (VAS) for current, most severe, and average pain. Neuropathic pain components were assessed with the PainDETECT questionnaire. Statistical analyses included independent-samples t-tests, Mann–Whitney U tests, and chi-square tests.Results: Mean age and sex distribution were similar between groups (p>0.05). VAS scores for current, most severe, and average pain did not significantly differ between L4-L5 and L5-S1 groups (p>0.05). However, a higher proportion of patients with L4-L5 herniation had PainDETECT scores ≥19, indicating probable neuropathic pain, compared with the L5-S1 group (63.0% vs. 26.9%, p=0.015). Radiating leg pain was also more common in the L4-L5 group (95.7% vs. 80.8%, p=0.042).Conclusions: While pain intensity was similar across groups, patients with L4-L5 herniations exhibited neuropathic pain features and radicular symptoms more frequently than those with L5-S1 herniations. These findings suggest that the anatomical level of disc herniation may influence pain quality, which could guide more tailored pain management strategies.