NeuPSIG guidelines on neuropathic pain assessment

Abstract

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.

A genome‐wide association study suggests an association of Chr8p21.3 (GFRA2) with diabetic neuropathic pain

“…The assessment of neuropathic pain has been internationally standardized for primary care and specialist settings (Haanpää et al., 2011; Jones and Backonja, 2013). However, these detailed assessment methods are not suitable for population‐based settings where thousands of patients are to be phenotyped.…”

“…However, these detailed assessment methods are not suitable for population‐based settings where thousands of patients are to be phenotyped. Although brief screening instruments, aimed at detecting pain with neuropathic characteristics, have been used in population‐based research, they are imperfect and have not been validated in general population settings (Haanpää et al., 2011). Therefore, there is no practically applicable neuropathic pain gold standard phenotype for large human studies.…”

Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck–arm pain

“…To our 6 knowledge, no study has profiled patients with unilateral NSNAP comparable to our cohort, and only one study documented sensory abnormalities in patients with cervical radiculopathy [13]. However, in the latter, recordings were not taken from the patients' maximal pain area, as is required for the assessment of NeP components [66,31].…”

Gabapentinoid Insensitivity after Repeated Administration is Associated with Down-Regulation of the α2δ-1 Subunit in Rats with Central Post-Stroke Pain Hypersensitivity

“…Central post-stroke pain (CPSP) is a type of central neuropathic pain that is induced by a primary lesion of the central somatosensory system following ischemic or hemorrhagic stroke [1][2][3]. CPSP occurs most often after strokes that involve the thalamus [4][5][6][7][8][9].…”

“…In 2004, gabapentinoids were also approved as first-line drugs for the treatment of some types of neuropathic pain, such as painful diabetic neuropathy, post-herpetic neuralgia, and spinal cord injury-induced pain [3,14,15,18]. Nonetheless, gabapentinoids are commonly used to treat other types of In a recent placebo-controlled trial, pregabalin failed to show significant improvement over placebo in patients with CPSP [19].…”