Assessment of neuropathic pain in primary care.
Management of patients presenting with chronic pain is a common problem in primary care. Essentially, the classification of chronic pain falls into 3 broad categories: (1) pain owing to tissue disease or damage (nociceptive pain), (2) pain caused by somatosensory system disease or damage (neuropathic pain), and (3) pain without a known somatic background. Key challenges in developing a targeted holistic approach to treatment include appropriate diagnosis of the cause or causes of pain; identifying the type of pain and assessing the relative importance of its various components; and determining appropriate treatment. In clinical examination, sensory abnormalities are the crucial findings leading to a diagnosis of neuropathic pain, for which pharmacotherapy with antidepressants and anticonvulsants represents the cornerstone of medical treatment. Chronic neuropathic pain is underrecognized and undertreated, yet primary care physicians are uniquely placed on the frontlines of patient management, where they can play a pivotal role in treatment and prevention through diagnosis, therapy, follow-up, and referral. This review provides guidance in understanding and identifying the neuropathic contribution to pain presenting in primary care; assessing its severity through patient history, physical examination, and appropriate diagnostic tests; and establishing a rational treatment plan.
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. maija.haanpaa@hus.fi
Maija L
ML
Haanpää
Misha-Miroslav
MM
Backonja
Michael I
MI
Bennett
Didier
D
Bouhassira
Giorgio
G
Cruccu
Per T
PT
Hansson
Troels Staehelin
TS
Jensen
Timo
T
Kauppila
Andrew S C
AS
Rice
Blair H
BH
Smith
Rolf-Detlef
RD
Treede
Ralf
R
Baron
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects; D003937:Diagnosis, Differential; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008408:Mastectomy / Q000009:adverse effects; D008487:Medical History Taking; D008875:Middle Aged; D009437:Neuralgia / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D010146:Pain / Q000175:diagnosis; D010147:Pain Measurement; D010808:Physical Examination; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects; D012720:Severity of Illness Index; D018119:Stavudine / Q000009:adverse effects; D013697:Thermosensing; D014110:Touch; D014732:Vibration
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine