What is Localized Neuropathic Pain? A First Proposal to Characterize and Define a Widely Used Term

Abstract

SUMMARY According to several guidelines, topical agents should be considered for the pharmacological management of localized neuropathic pain. As a definition for the term 'localized neuropathic pain' that might facilitate easier identification of patients who are putatively responsive to topical treatments could not be found in the literature, six pain specialists met in 2010 to address this challenging issue. The following nucleus of a definition that is based on the International Association for the Study of Pain (IASP) definition of neuropathic pain, is the most detailed that can currently be proposed: 'Localized neuropathic pain is a type of neuropathic pain that is characterized by consistent and circumscribed area(s) of maximum pain'. An extended version of this core definition and the difficulties in covering all aspects of localized neuropathic pain are presented, and discussions within the scientific community are encouraged to develop a definition that might help to identify patients who could benefit most from topical treatment.

Is an easy and reliable diagnosis of localized neuropathic pain (LNP) possible in general practice? Development of a screening tool based on IASP criteria

“…Sample size calculations were based on the assumption that 6-8% of adults in the general population suffer from chronic pain with neuropathic characteristics 12 , among those about 60% present with LNP 14 . As a result, one in 25 patients experiencing chronic pain might suffer from LNP.…”

“…The topographical distribution of NP varies among patients according to NP etiology; in some pain conditions, pain is clearly localized in a circumscribed area of the body for the majority of patients resulting in the use of the term 'localized neuropathic pain' (LNP) (note that 'focal' is sometimes used instead of 'localized' for the same situation). The lack of a definition for LNP in the literature and a poor understanding of the term by physicians of several Western European countries 14 led to the recent proposal of a core definition: ''Localized neuropathic pain is a type of neuropathic pain that is characterized by consistent and circumscribed area(s) of maximum pain'' 14 . Patients with LNP should be able to point to the location(s) of their pain or abnormal sensations on the skin in order to distinguish LNP from widely distributed or even widespread pain, the area of maximal pain remaining relatively constant over time 14 .…”

“…The lack of a definition for LNP in the literature and a poor understanding of the term by physicians of several Western European countries 14 led to the recent proposal of a core definition: ''Localized neuropathic pain is a type of neuropathic pain that is characterized by consistent and circumscribed area(s) of maximum pain'' 14 . Patients with LNP should be able to point to the location(s) of their pain or abnormal sensations on the skin in order to distinguish LNP from widely distributed or even widespread pain, the area of maximal pain remaining relatively constant over time 14 . A survey in Western Europe showed that LNP may be common: averaging across all NP conditions, physicians reported that pain was localized in approximately 60% of NP patients 14 .…”

“…Patients with LNP should be able to point to the location(s) of their pain or abnormal sensations on the skin in order to distinguish LNP from widely distributed or even widespread pain, the area of maximal pain remaining relatively constant over time 14 . A survey in Western Europe showed that LNP may be common: averaging across all NP conditions, physicians reported that pain was localized in approximately 60% of NP patients 14 .…”

The role of topiceuticals in cancer pain

“…This details a stepwise approach using systemic treatments such as anticonvulsants and antidepressants. However, it has recently been noted that just over half of cancer patients with neuropathic pain will have a consistent and circumscribed area of maximum pain [9]. It is this 'localised neuropathic pain' (LNP) that forms the basis for using topiceuticals in cancer-related pain.…”