NeuPSIG guidelines on neuropathic pain assessment.
This is a revision of guidelines, originally published in 2004, for the assessment of patients with neuropathic pain. Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system either at peripheral or central level. Screening questionnaires are suitable for identifying potential patients with neuropathic pain, but further validation of them is needed for epidemiological purposes. Clinical examination, including accurate sensory examination, is the basis of neuropathic pain diagnosis. For more accurate sensory profiling, quantitative sensory testing is recommended for selected cases in clinic, including the diagnosis of small fiber neuropathies and for research purposes. Measurement of trigeminal reflexes mediated by A-beta fibers can be used to differentiate symptomatic trigeminal neuralgia from classical trigeminal neuralgia. Measurement of laser-evoked potentials is useful for assessing function of the A-delta fiber pathways in patients with neuropathic pain. Functional brain imaging is not currently useful for individual patients in clinical practice, but is an interesting research tool. Skin biopsy to measure the intraepidermal nerve fiber density should be performed in patients with clinical signs of small fiber dysfunction. The intensity of pain and treatment effect (both in clinic and trials) should be assessed with numerical rating scale or visual analog scale. For future neuropathic pain trials, pain relief scales, patient and clinician global impression of change, the proportion of responders (50% and 30% pain relief), validated neuropathic pain quality measures and assessment of sleep, mood, functional capacity and quality of life are recommended.
Haanpää
Maija
M
Rehabilitation ORTON, Helsinki, Finland Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France Université Versailles Saint-Quentin, France Department of Neurology, University of Wisconsin, Madison, WI, USA Division of Neurological Pain Research and Therapy, Department of Neurology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany Institute of Health Research, Lancaster University, Lancaster University, Lancaster, UK Department of Neurology, La Sapienza University, Rome, Italy Pain Center, Department of Anesthesiology and Intensive Care, Clinical Pain Research, Karolinska University Hospital/Institutet, Stockholm, Sweden Johns Hopkins University, Baltimore, MD, USA Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK Danish Pain Research Center and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark Korso-Koivukylä Health Centre, Vantaa, Finland Network of Academic Health Centres, Departments of General Practice and Primary Healthcare, Institute of Clinical Medicine and Department of National Public Health, University of Helsinki, Helsinki, Finland Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK Department of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK Department of Neurology, QCSF Pain Clinic Research Center, University of California, San Francisco, CA, USA Department of Neurology, MC Mutual & Neuroscience Technologies, Barcelona Science Park, Barcelona, Spain Department of Neurology, University of Würzburg, Germany Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK Center for Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany.
Attal
Nadine
N
Backonja
Miroslav
M
Baron
Ralf
R
Bennett
Michael
M
Bouhassira
Didier
D
Cruccu
Giorgio
G
Hansson
Per
P
Haythornthwaite
Jennifer A
JA
Iannetti
Gian Domenico
GD
Jensen
Troels S
TS
Kauppila
Timo
T
Nurmikko
Turo J
TJ
Rice
Andew S C
ASC
Rowbotham
Michael
M
Serra
Jordi
J
Sommer
Claudia
C
Smith
Blair H
BH
Treede
Rolf-Detlef
RD
D001341:Autonomic Nervous System / Q000503:physiopathology; D016208:Databases, Factual / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000379:methods; D004185:Disability Evaluation; D005071:Evoked Potentials / Q000502:physiology; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D008403:Mass Screening; D009437:Neuralgia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D011581:Psychological Tests; D011602:Psychophysiologic Disorders; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors