Neuropathic Pain

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Definition

Complex type of pain initiated or caused by a primary lesion or dysfunction in the nervous system (IASP, 2012).

Cause

Damage can be caused by trauma, surgery or disease processes including diabetes,infection (eg after shingles infection - post-herpetic neuralgia) and cancer.

Has a peripheral origin and may develop central sensitization but "primary afferent input is critical for maintaining neuropathic pain in peripheral nerve injury and distal polyneuropathy" Haroutounian S, Nikolajsen L, Bendtsen TF, Finnerup NB, Kristensen AD, Hasselstrøm JB, & Jensen TS (2014). Primary afferent input critical for maintaining spontaneous pain in peripheral neuropathy. Pain, 155 (7), 1272-9

Pain may be generated in peripheral nerve, dorsal root ganglion,

Assessment

Examination of a Patient with Peripheral Neuropathic Pain shows a real patient with multiple mononeuropathy due to isolated peripheral nervous system vasculitis. He is suffering from neuropathic pain in his left hand and both legs. Functional assessment and sensory and motor examination of both upper and lower limbs is demonstrated

File:Http://www.youtube.com/watch?v=MJxeI a04Xc

DN4 – QUESTIONNAIRE Assists with neuropathic pain assessment

Use when neuropathic pain is suspected.

What to do • Interview questionnaires and physical tests. • If score ≥ 4, consider anti-neuropathic medication

DN4 – QUESTIONNAIRE To estimate the probability of neuropathic pain, please answer yes or no for each item of the following four questions. INTERVIEW OF THE PATIENT QUESTION 1: Does the pain have one or more of the following characteristics? YES NO Burning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ Painful cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ Electric shocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ QUESTION 2: Is the pain associated with one or more of the following symptoms in the same area? YES NO Tingling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ Pins and needles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ Numbness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ Itching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ EXAMINATION OF THE PATIENT QUESTION 3: Is the pain located in an area where the physical examination may reveal one or more of the following characteristics? YES NO Hypoesthesia to touch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ Hypoesthesia to pinprick . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ QUESTION 4: In the painful area, can the pain be caused or increased by: YES NO Brushing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❏ ❏ YES = 1 point NO = 0 points Patient’s Score: /10

Ref : http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0014/212900/DN4_Assessment_Tool.pdf Add text here...

References

International Association for the Study of Pain(lASP) http://www.iasp-pain.org/

Haroutounian S, Nikolajsen L, Bendtsen TF, Finnerup NB, Kristensen AD, Hasselstrøm JB, & Jensen TS (2014). Primary afferent input critical for maintaining spontaneous pain in peripheral neuropathy. Pain, 155 (7), 1272-9 PMID: 24704366

http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0014/212900/DN4_Assessment_Tool.pdf