title: Diagnosing neuropathic pain in patients with cancer: comparative analysis of recommendations in national guidelines from European countries.
abstract: BACKGROUND
  Neuropathic pain is a prevalent symptom in patients with cancer, which needs a more specific algorithm than nociceptive pain or neuropathic pain from other origin. Clinical practice guidelines (CPGs) can be helpful in optimizing the diagnosis of neuropathic pain in patients with cancer.
  
  
  METHODS
  In this study, 9 national CPGs in Europe on the diagnosis of neuropathic pain in patients with cancer were included. Recommendations with their grade (according SIGN 55 classification) and supporting literature (first author, patients' population, year, and type of publication) were compared between CPGs.
  
  
  RESULTS
  Nine CPGs including recommendations on neuropathic pain could be selected and were assessed. In total, they used 149 references of which 72 (48%) were about cancer conditions, 39 (26%) about neuropathic pain, and only 3 about neuropathic pain in patients with cancer (2%). Only 28 (19%) references were shared between 2 or more guidelines. There was only one shared reference specifically related to cancer neuropathic pain. Recommendations and their evidence grading strongly differ between CPGs.
  
  
  CONCLUSIONS
  This work demonstrates an important heterogeneity between European recommendations on diagnosis and assessment of neuropathic pain in patients with cancer. The main weaknesses are the low level of evidence and the absence of specific data focusing on neuropathic pain in patients with cancer. We recommend that physicians dealing with neuropathic pain in patients with cancer should be specially trained, that a specific methodology to develop CPGs should followed, and that specific research should be developed on the diagnosis of neuropathic pain in patients with cancer.
authors.affiliation: Department of Pain and Palliative Care, University Nice Medical Centre, Nice, France. virginie.piano@ap-hm.fr
authors.forename: Virginie
authors.initials: V
authors.lastname: Piano
authors.forename: Stans
authors.initials: S
authors.lastname: Verhagen
authors.forename: Annelies
authors.initials: A
authors.lastname: Schalkwijk
authors.forename: Jako
authors.initials: J
authors.lastname: Burgers
authors.forename: Hans
authors.initials: H
authors.lastname: Kress
authors.forename: Rolf-Detlef
authors.initials: RD
authors.lastname: Treede
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Hekster
authors.forename: Michel
authors.initials: M
authors.lastname: Lanteri-Minet
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
mesh_terms: D005060:Europe / Q000453:epidemiology; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D009437:Neuralgia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D010147:Pain Measurement / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*
keywords: CPG; European guidelines; Neuralgia; cancer; clinical practice guidelines; evidence-based medicine; pain Assessment