PAIN
Volume 152, Issue 1 , Pages 14-27, January 2011

NeuPSIG guidelines on neuropathic pain assessment

  • Maija Haanpää

      Affiliations

    • Rehabilitation ORTON, Helsinki, Finland
    • Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
    • Corresponding Author InformationCorresponding author at: Department of Neurosurgery, Helsinki University Central Hospital, P.O. Box 266, 00029 HUS, Helsinki, Finland. Tel.: +358 50 5837722; fax: +358 9 47187560.
    • ,
  • Nadine Attal

      Affiliations

    • INSERM U-987, Centre d’Evaluation et de Traitement de la Douleur, Hoˆpital Ambroise Pare´, APHP, Boulogne-Billancourt, France
    • Universite´ Versailles Saint-Quentin, France
    • ,
  • Miroslav Backonja

      Affiliations

    • Department of Neurology, University of Wisconsin, Madison, WI, USA
    • ,
  • Ralf Baron

      Affiliations

    • Division of Neurological Pain Research and Therapy, Department of Neurology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
    • ,
  • Michael Bennett

      Affiliations

    • Institute of Health Research, Lancaster University, Lancaster University, Lancaster, UK
    • ,
  • Didier Bouhassira

      Affiliations

    • INSERM U-987, Centre d’Evaluation et de Traitement de la Douleur, Hoˆpital Ambroise Pare´, APHP, Boulogne-Billancourt, France
    • Universite´ Versailles Saint-Quentin, France
    • ,
  • Giorgio Cruccu

      Affiliations

    • Department of Neurology, La Sapienza University, Rome, Italy
    • ,
  • Per Hansson

      Affiliations

    • Pain Center, Department of Anesthesiology and Intensive Care, Clinical Pain Research, Karolinska University Hospital/Institutet, Stockholm, Sweden
    • ,
  • Jennifer A. Haythornthwaite

      Affiliations

    • Johns Hopkins University, Baltimore, MD, USA
    • ,
  • Gian Domenico Iannetti

      Affiliations

    • Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
    • ,
  • Troels S. Jensen

      Affiliations

    • Danish Pain Research Center and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
    • ,
  • Timo Kauppila

      Affiliations

    • Korso-Koivukylä Health Centre, Vantaa, Finland
    • Network of Academic Health Centres, Departments of General Practice and Primary Healthcare, Institute of Clinical Medicine and Department of National Public Health, University of Helsinki, Helsinki, Finland
    • ,
  • Turo J. Nurmikko

      Affiliations

    • Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
    • ,
  • Andew S.C. Rice

      Affiliations

    • Department of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
    • ,
  • Michael Rowbotham

      Affiliations

    • Department of Neurology, QCSF Pain Clinic Research Center, University of California, San Francisco, CA, USA
    • ,
  • Jordi Serra

      Affiliations

    • Department of Neurology, MC Mutual & Neuroscience Technologies, Barcelona Science Park, Barcelona, Spain
    • ,
  • Claudia Sommer

      Affiliations

    • Department of Neurology, University of Würzburg, Germany
    • ,
  • Blair H. Smith

      Affiliations

    • Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
    • ,
  • Rolf-Detlef Treede

      Affiliations

    • Center for Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany

Received 29 August 2009; received in revised form 2 July 2010; accepted 29 July 2010. published online 20 September 2010.

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.

Keywords: Assessment, Autonomic nervous system, Clinical examination, Disability, Functional brain imaging, Epidemiology, Evoked potentials, Pain measurement, Microneurography, Neuropathic pain, Pain intensity, Pain quality, Psychological assessment, Quality of life, Screening tools, Skin biopsy, Somatosensory testing, Treatment efficacy, Trigeminal reflexes

 

PII: S0304-3959(10)00453-7

doi:10.1016/j.pain.2010.07.031

Refers to article:

  • Reassessment of neuropathic pain in light of its revised definition: Possible implications and consequences , 09 August 2010

    Elon Eisenberg
    PAIN January 2011 (Vol. 152, Issue 1, Pages 2-3)

PAIN
Volume 152, Issue 1 , Pages 14-27, January 2011

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