The diagnosis and management of neuropathic pain in daily practice in Belgium: an observational study.
BACKGROUND
This open, multicentre, observational survey investigated how physicians diagnose neuropathic pain (NeP) by applying the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, and how neuropathic pain conditions are managed in daily practice in Belgium.


METHODS
Physicians were asked to complete the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale for diagnosing NeP, and to fill out a questionnaire regarding the management of NeP, together with a questionnaire evaluating the impact of pain on sleep and daily life. Data on 2,480 pain patients were obtained. A LANSS score > or = 12 (meaning NeP is most probably present) was reported for 1,163 patients. Pathologies typically associated with NeP scored above 12 on the LANSS scale, contrary to pathologies generally considered as being of non-neuropathic origin.


RESULTS
Over 90% of the patients with a LANSS score > or = 12 reported that the pain impaired sleep. A high impact on social, family and professional life was also recorded. Additional examinations were performed in 89% of these patients. Most patients were taking multiple drugs, mainly paracetamol and non-steroidal anti-inflammatory drugs, indicating that physicians generally tend to follow treatment guidelines of chronic nociceptive pain, rather than the specific ones for NeP. Specific neuropathic guidelines rather recommend the use of anti-epileptic drugs, tricyclic antidepressants or weak opioids as first-line treatment.


CONCLUSIONS
In our survey, application of the LANSS scale lead to pronounced treatment simplification with fewer drug combinations. Awareness about NeP as well as its specific treatment recommendations should be raised among healthcare providers. We concluded that the LANSS screening scale is an interesting tool to assist physicians in detecting NeP patients in routine clinical care.
Hans
Guy
G
Multidisciplinary Pain Center, Antwerp University Hospital (UZA), Edegem, Belgium. guy.hans@uza.be
Masquelier
Etienne
E
De Cock
Patricia
P
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D002983:Clinical Competence; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis* / Q000503:physiopathology; D009619:Nociceptors / Q000187:drug effects; D019370:Observation; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods*; D010818:Practice Patterns, Physicians'; D012680:Sensitivity and Specificity; D018434:Sickness Impact Profile; D012890:Sleep