Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Attal, Nadine; Fermanian, C.; Fermanian, Jacques; Lantéri-Minet, Michel; Alchaar, H.; Bouhassira, Didier

doi:10.1016/j.pain.2008.01.006

Cited by 256 publications

(162 citation statements)

References 39 publications

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“…The presence of at-level SCI pain is suggested by characteristics such as: 4,5,9,16,20,21 Sensory deficits within the pain distribution Allodynia or hyperalgesia within the pain distribution Endorsement of one or more of the following pain descriptors: 'hot-burning' , 'tingling' , 'pricking' , 'pins and needles' , 'sharp' , 'shooting' , 'squeezing' , 'painful cold' and 'electric shock-like' Pain occurring in a segmental pattern as described above, which is thought to be due to syringomyelia, should be classified as at-level SCI pain or, more specifically (using tier 3 entries), at-level SCI pain due to/associated with syringomyelia. Note that the current NLI often is higher than the original NLI in patients who develop syringomyelia following a SCI.…”

Section: Nociceptive Pain Typesmentioning

confidence: 99%

“…Neuropathic pain that occurs in this distribution and that cannot be attributed to the spinal cord damage should be classified as other (neuropathic) pain. The presence of below-level SCI pain is suggested by characteristics such as: 4,5,9,16,[20][21][22] Sensory deficits within the pain distribution Allodynia or hyperalgesia within the pain distribution (for persons with incomplete injury) Endorsement of one or more of the following pain descriptors: 'hot-burning' , 'tingling' , 'pricking' , 'pins and needles' , 'sharp' , 'shooting' , 'squeezing' , 'painful cold' and 'electric shock-like' Below-level SCI pain can occur in persons with complete injuries and in those with incomplete injuries. Neuropathic pain associated with cauda equina damage is radicular in nature, and therefore defined as at-level SCI (neuropathic) pain, regardless of distribution.…”

Section: Nociceptive Pain Typesmentioning

confidence: 99%

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International Spinal Cord Injury Pain Classification: part I. Background and description

et al. 2011

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Study design: Discussion of issues and development of consensus. Objective: Present the background, purpose, development process, format and definitions of the International Spinal Cord Injury Pain (ISCIP) Classification. Methods: An international group of spinal cord injury (SCI) and pain experts deliberated over 2 days, and then via e-mail communication developed a consensus classification of pain after SCI. The classification was reviewed by members of several professional organizations and their feedback was incorporated. The classification then underwent validation by an international group of clinicians with minimal exposure to the classification, using case study vignettes. Based upon the results of this study, further revisions were made to the ISCIP Classification. Results: An overall structure and terminology has been developed and partially validated as a merger of and improvement on previously published SCI pain classifications, combined with basic definitions proposed by the International Association for the Study of Pain and pain characteristics described in published empiric studies of pain. The classification is designed to be comprehensive and to include pains that are directly related to the SCI pathology as well as pains that are common after SCI but are not necessarily mechanistically related to the SCI itself. Conclusions:The format and definitions presented should help experienced and non-experienced clinicians as well as clinical researchers classify pain after SCI.

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Section: Nociceptive Pain Typesmentioning

confidence: 99%

Section: Nociceptive Pain Typesmentioning

confidence: 99%

International Spinal Cord Injury Pain Classification: part I. Background and description

et al. 2011

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“…On the basis of clinical experience and analysis of the literature, 5,6,[15][16][17][18][19] the primary author compiled a list of seven characteristics associated with NP after SCI (see Appendix A for a description of the items). The first three items concerned the pain descriptors that are most commonly associated with NP after SCI.…”

Section: Introductionmentioning

confidence: 99%

Screening for neuropathic pain after spinal cord injury with the Spinal Cord Injury Pain Instrument (SCIPI): a preliminary validation study

et al. 2014

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Study design: Cross-sectional. Objective: To preliminarily evaluate the validity of an interview-based spinal cord injury (SCI) neuropathic pain screening instrument. Setting: Six university-based SCI centers in the United States. Methods: Clinician diagnoses of neuropathic pain (NP) and non-neuropathic pain subtypes were collected independently of descriptions of the pain characteristics provided by the persons with SCI by using the Spinal Cord Injury Pain Instrument (SCIPI); SCIPI information and physician diagnoses for 82 pain sites of which they were most confident were subsequently compared. Results: Four of the SCIPI items correlated significantly with the NP subtype as determined by the clinician. The best cutoff score for identifying NP was an endorsement of two or more of these four items. Using this cutoff, sensitivity of the SCIPI was 78%, specificity was 73% and overall diagnostic accuracy was 76%. Conclusion: In this preliminary study, the SCIPI, which can be administered by a nonclinician, appears to have good sensitivity, specificity and diagnostic accuracy in a SCI population; it may have a role as a screening tool for NP after SCI. Further study is needed.

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“…In addition, appreciation of the considerable heterogeneity among different NP conditions is increasing, not only in responsiveness to different treatments but also in other factors, such as their patterns of signs and symptoms (ie, their "sensory phenotype"). 16,17 Moreover, the lack of direct comparisons of different medications makes it difficult to contrast and rank medications on the basis of efficacy, safety, and tolerability. Therefore, the choice of medication in an individual patient with NP depends on a number of factors, including the potential for adverse effects, treatment of comorbidities (eg, depression, sleep disorders), drug interactions, risks of misuse and abuse, and cost.…”

mentioning

confidence: 99%

Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update

Dworkin

O’Connor

Audette

et al. 2010

Mayo Clinic Proceedings

1,130

901

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The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain recently sponsored the development of evidence-based guidelines for the pharmacological treatment of neuropathic pain. Tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, calcium channel a 2 -d ligands (ie, gabapentin and pregabalin), and topical lidocaine were recommended as first-line treatment options on the basis of the results of randomized clinical trials. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in certain clinical circumstances. Results of several recent clinical trials have become available since the development of these guidelines. These studies have examined botulinum toxin, high-concentration capsaicin patch, lacosamide, selective serotonin reuptake inhibitors, and combination therapies in various neuropathic pain conditions. The increasing number of negative clinical trials of pharmacological treatments for neuropathic pain and ambiguities in the interpretation of these negative trials must also be considered in developing treatment guidelines. The objectives of the current article are to review the Neuropathic Pain Special Interest Group guidelines for the pharmacological management of neuropathic pain and to provide a brief overview of these recent studies.Mayo Clin Proc. 2010;85(3)(suppl):S3-S14 DPN = diabetic peripheral neuropathy; HIV = human immunodeficiency virus; HRQoL = health-related quality of life; NeuPSIG = Neuropathic Pain Special Interest Group; NP = neuropathic pain; PHN = postherpetic neuralgia; RCT = randomized clinical trial; SSNRI = selective serotonin norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant

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Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Cited by 256 publications

References 39 publications

International Spinal Cord Injury Pain Classification: part I. Background and description

International Spinal Cord Injury Pain Classification: part I. Background and description

Screening for neuropathic pain after spinal cord injury with the Spinal Cord Injury Pain Instrument (SCIPI): a preliminary validation study

Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update

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