title: Is an easy and reliable diagnosis of localized neuropathic pain (LNP) possible in general practice? Development of a screening tool based on IASP criteria.
abstract: OBJECTIVE
  Neuropathic pain (NP) is a common type of chronic pain in which 60% of patients present with localized symptoms. Early diagnosis of NP is often a challenge in primary care. Moreover, so far no standard diagnostic procedure for localized NP (LNP) is available. To help general practitioners, a screening tool was developed and evaluated.
  
  
  METHODS
  The development of the screening tool was based on the grading system principles for NP proposed by the IASP, focusing on medical history and distribution of painful symptoms and sensory signs. It was tested by 31 general practitioners and evaluated against the NP diagnosis of three pain specialists as reference in a single center prospective study in Spain using a cohort study design including an adult population of chronic pain patients. This design avoids spectrum bias where the spectrum of disease is not correctly reflected in the study population.
  
  
  METHODS
  General practitioners rated usefulness, simplicity, and time requirements of the tool. Diagnostic accuracy was expressed by sensitivity, specificity, and positive and negative predictive values.
  
  
  RESULTS
  General practitioners consecutively screened 2079 chronic pain patients (mean age 60.7 ± 11.1 years, 69.9% female). Using the tool, 394 patients were diagnosed with LNP. Screening including sensory examination took 7 min (median). General practitioners rated the tool as useful (24/31; 77.4%) or very useful (7/31; 22.6%) for diagnosing LNP and facilitating clinical practice (30/31; 96.8%). Under daily practice conditions, sensitivity and specificity of the tool for detecting LNP was 46.7% and 86.6%, respectively.
  
  
  CONCLUSIONS
  The proposed screening tool was shown to be easy and useful for detecting NP and LNP in chronic pain patients as a fast first assessment tool in primary care, thus facilitating the choice of a topical treatment. LIMITATIONS AND STRENGTHS: The drop-out rate was high but was accounted for by using correction factors in the diagnostic accuracy calculations. A strength is the unselected chronic patient population: spectrum of disease correctly reflects day-to-day clinical practice and is not biased. Diagnostic accuracy of the tool therefore appears to be realistic.
authors.affiliation: Center for Pain Evaluation and Treatment, Neurological Hospital , Lyon , France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Mick
authors.forename: Ralf
authors.initials: R
authors.lastname: Baron
authors.forename: Gerardo
authors.initials: G
authors.lastname: Correa-Illanes
authors.forename: Guy
authors.initials: G
authors.lastname: Hans
authors.forename: Victor
authors.initials: V
authors.lastname: Mayoral
authors.forename: Xavier
authors.initials: X
authors.lastname: Frías
authors.forename: Dolors
authors.initials: D
authors.lastname: Sintes
authors.forename: Thomas
authors.initials: T
authors.lastname: Keller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000175:diagnosis*; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013030:Spain
keywords: Diagnostic accuracy; Evaluation; General practitioner; Localized neuropathic pain; Pain diagnosis; Primary care; Screening tool