Clinical presentation and diagnosis of neuropathic pain

Abstract

BACKGROUND AND OBJECTIVES:Neuropathic pain is reason for distress and incapacity of several patients, being that symptoms, mechanisms and management distinguish it from nociceptive pain. This study aimed at discussing the clinical presentation and diagnosis of neuropathic pain. CONTENTS: Neuropathic pain is manifested by several symptoms, being continuous burning pain, shock sensation and mechanical alodynia the most common ones. Neurophysiologic studies and skin biopsy suggest that burning pain is reflex of spontaneous activity of afferent nociceptive fibers, while shock sensation is originated from high frequency ectopic stimuli, generated in demyelinated Aβ fibers. Clinical exam, made up of history and elementary physical neurological evaluation, is critical for the adequate diagnosis of the type of pain, as well as more detailed exams, such as quantitative sensory tests and confocal optic microscopy, may bring further subsidies to the diagnosis of the type of pain. CONCLUSION: Clinical presentation of neuropathic pain has characteristics which help the accurate diagnosis of the syndrome or disease responsible for the onset of the complaint. Adequate clinical evaluation, including directed physical neurologic exam, sensory quantitative tests and cornea confocal microscopy cooperate for a more accurate diagnosis. Keywords: Clinical presentation, Diagnosis, Neuropathic pain. RESUMO JUSTIFICATIVA E OBJETIVOS:A dor neuropática é motivo de sofrimento e incapacidade para muitos pacientes, sendo que os seus sintomas, mecanismos e tratamento a distinguem da dor nociceptiva. O objetivo deste estudo foi discutir o quadro clínico e o diagnóstico da dor neuropática. CONTEÚDO: A dor neuropática se manifesta por meio de vários sintomas, sendo os mais comuns a dor contínua em queimação, sensação de choque e alodínea mecânica. Estudos neurofisiológicos e biópsia de pele sugerem que dor em queimação é reflexo de atividade espontânea em fibras nociceptivas aferentes, enquanto a sensação de choque presumidamente é originada de estímulos ectópi-cos de alta frequência, gerados em fibras Aβ desmielinizadas. O exame clínico, constituído por anamnese e exame físico neurológico elementar é de primordial importância para o adequado diagnóstico do tipo de dor. Assim como exames mais minuciosos, como os testes sensoriais quantitativos e a microscopia ótica confocal, podem trazer subsídios mais aprofundados ao diagnóstico do tipo de dor. CONCLUSÃO: O quadro clínico da dor neuropática possui características que auxiliam no correto diagnóstico da síndrome ou doença que seja a responsável pelo aparecimento da queixa. Adequado exame clínico, incluindo a realização de exame físico neurológico dirigido, juntamente com os testes quantitativos sensoriais e com o exame de microscopia confocal de córnea colaboram para a execução mais precisa do diagnóstico. Descritores: Diagnóstico, Dor neuropática, Quadro clínico.

Chronic postoperative pain: ubiquitous and scarcely appraised: narrative review

“…It is interesting to assess patients’ functional history, such as how symptoms interfere with mobility, day-to-day activities, interpersonal relationships, sleep, and mood. 42 …”

Evaluation of Neuropathic Pain Scale Knowledge

“…For this reason, the basic concepts of a clinical examination for the patient suspected of neuropathic pain should be known to all clinicians who treat patients with pain. 6 NP can be classified as spontaneous (burning, tightening, pressure) and provoked (stabbing and shock) by brushing against the skin, pressure, and/or by thermal stimulation. Patients with NP also complain of paresthesic symptoms, such as tingling, stabbing pains, and pin pricks, and the presence of hyperalgesia (increased response to a painful stimulus) is common.…”

“…Patients with NP also complain of paresthesic symptoms, such as tingling, stabbing pains, and pin pricks, and the presence of hyperalgesia (increased response to a painful stimulus) is common. 6 NP has received special attention due to the therapeutic refractoriness that it presents and to the development of diagnostic tools for recognizing this type of pain. 7 In spite of the development of neurophysiological and neuroimaging methods, collecting patient history and conducting the patient physical examination using simple propaedeutic tools remains the most important step in the diagnostic process.…”

Validity and reliability of Arabic version of the ID Pain screening questionnaire in the assessment of neuropathic pain

“…The International Association for the Study of Pain (IASP) defines NP as “pain caused by a lesion or disease of the somatosensory nervous system” [ 3 , 4 ]. A large number of patients are affected by chronic NP with an estimated prevalence of 6.9% to 10% [ 5 ]. Common signs and symptoms of NP include mechanical allodynia, burning sensation, electric shock sensation, hyperalgesia, etc.…”