Towards a mechanism-based classification of pain?

Woolf, Clifford J.; Bennett, Gary J.; Doherty, Michael; Dubner, Ronald; Kidd, Bruce L.; Koltzenburg, M; Lipton, Richard B.; Loeser, John D.; Payne, Richard K.; Torebjörk, E

doi:10.1016/s0304-3959(98)00099-2

Cited by 495 publications

(273 citation statements)

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“…Or is it possible that specific characteristics of the study population, the selected patient group, or the defined primary outcome have obscured a positive response? 8 These observations have raised the question of whether an entirely different strategy, in which pain is analyzed on the basis of underlying mechanisms, could 3,9 have emphasized the rationale for a treatment approach directed at one or more mechanisms rather than at diseases because new treatments are being developed on the basis of the biological mechanisms that underlie pain. One area that needs such a new approach is neuropathic pain.…”

Section: Rationale For a New Classificationmentioning

confidence: 99%

Evaluation of Symptom Heterogeneity in Neuropathic Pain Using Assessments of Sensory Functions

Arning

Baron

2009

Neurotherapeutics

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Summary:Classification of neuropathic pain has been based on disease entities, anatomical localization, or histological observations. Over the past decade, there has been an explosion in our understanding of the basic mechanisms of neuropathic pain. The exciting advances in basic science are paralleled by the recognition from clinical investigations that neuropathic pain is not a monolithic entity, but instead presents as a composite of pain and other sensory symptoms. Attempts are under way to supplement the traditional classification with a classification that links pain and sensory symptoms with neurobiological mechanisms. This mechanism-or symptom-based classification takes both negative and positive sensory symptoms into account. By using a battery of several standardized quantitative sensory tests, the characteristic profile of sensory symptoms can be elucidated in each patient. Moreover, in questionnaires the verbal descriptors can depict the quality and intensity of the individual pain. The approach of classifying and subgrouping patients with neuropathic pain on the basis of symptoms or signs opens up new possibilities for stratifying patients in clinical trials. First, in clinical proof-of-concept trials the study population can be enriched prospectively on the basis of entry criteria defined a priori. This enrichment with patients who potentially require a specific treatment should increase the likelihood for positive trial outcomes. Second, in clinical practice it becomes possible to establish an individualized therapy-that is, to identify the particular patients who require a specific treatment option.

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Section: Rationale For a New Classificationmentioning

confidence: 99%

Evaluation of Symptom Heterogeneity in Neuropathic Pain Using Assessments of Sensory Functions

Arning

Baron

2009

Neurotherapeutics

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“…For patients with complex pain conditions related to nerve injury, it has been suggested that a mechanism based classification system may be most appropriate, as it provides a better understanding of the presenting complaint, along with direction for treatments which interact with specific neurophysiologic pain mechanisms [11]. Ours is the first classification system to apply this approach to low back and leg pain (LB&LP), taking into account central and peripheral pain mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

et al. 2010

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The objective is to determine if pain and disability outcomes of patients treated with neural mobilisation differ for sub-classifications of low back and leg pain (LB&LP). Radiating leg pain is a poor prognostic factor for recovery in patients with LBP. To improve outcome, a new pathomechanism-based classification system was proposed: neuropathic sensitization (NS), denervation (D), peripheral nerve sensitization (PNS) and musculoskeletal (M). Seventy-seven patients with unilateral LB&LP were recruited. Following classification, all subjects were treated seven times with neural mobilisation techniques. A successful outcome was defined as achieving a minimal clinically important change in pain intensity (11-point numerical rating scale), physical function (Roland Morris disability questionnaire) and global perceived change (7-point Likert scale: from 1 = ''completely recovered'' to 7 = ''worse than ever''). The proportion of responders was significantly greater in PNS (55.6%) than the other three groups (NS 10%; D 14.3% and M10%). After adjusting for baseline differences, mean magnitude of improvement of the outcome measures were significantly greater in PNS compared to the other groups. Patients classified as PNS have a more favourable prognosis following neural mobilisation compared to the other groups.

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“…As a mechanisms-based classification of pain, where pain is classified according to the dominant neurophysiological mechanisms responsible for its generation and/or maintenance (Woolf et al 1998;Portenoy, 1989) PNP has been proposed as a category of pain distinct from other mechanisms-based classifications of pain, such as 'nociceptive' pain (NP) and 'central sensitisation' pain (CSP) (Butler, 2000;Smart et al 2008;Costigan et al 2009;). Whilst many clinical presentations of pain may be attributable to a mix of nociceptive, peripheral neuropathic and central mechanisms, the concept of pain arising from a relative dominance of PNP mechanisms has been proposed (Bennett et al 2006;Schäfer et al 2009).…”

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confidence: 99%

Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (±leg) pain

et al. 2012

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Towards a mechanism-based classification of pain?

Cited by 495 publications

References 0 publications

Evaluation of Symptom Heterogeneity in Neuropathic Pain Using Assessments of Sensory Functions

Evaluation of Symptom Heterogeneity in Neuropathic Pain Using Assessments of Sensory Functions

Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (±leg) pain

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