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.
aRehabilitation ORTON, Helsinki, Finland
bDepartment of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
cINSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
dUniversité Versailles Saint-Quentin, France
eDepartment of Neurology, University of Wisconsin, Madison, WI, USA
fDivision of Neurological Pain Research and Therapy, Department of Neurology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
gInstitute of Health Research, Lancaster University, Lancaster University, Lancaster, UK
hDepartment of Neurology, La Sapienza University, Rome, Italy
iPain Center, Department of Anesthesiology and Intensive Care, Clinical Pain Research, Karolinska University Hospital/Institutet, Stockholm, Sweden
jJohns Hopkins University, Baltimore, MD, USA
kDepartment of Neuroscience, Physiology and Pharmacology, University College London, London, UK
lDanish Pain Research Center and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
mKorso-Koivukylä Health Centre, Vantaa, Finland
nNetwork 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
oPain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
pDepartment of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
qDepartment of Neurology, QCSF Pain Clinic Research Center, University of California, San Francisco, CA, USA
rDepartment of Neurology, MC Mutual & Neuroscience Technologies, Barcelona Science Park, Barcelona, Spain
sDepartment of Neurology, University of Würzburg, Germany
tCentre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
uCenter for Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany
*Corresponding 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.
Submitted August 29, 2009; revised July 2, 2010; accepted July 29, 2010.