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 == Assessing neuropathic pain Step 1. A clinical history of disease or lesion of the somatosensory system suggests a possible diagnosis of neuropathic pain Step 2. Confirmation by either clinically reproducible signs or investigations would suggest a probable diagnosis of neuropathic pain Step 3. If the history, clinical examination and investigations are positive, this would support a definite diagnosis of neuropathic pain Adapted from Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630–5 Sensory examination - light touch, temperature, painful stimulus, vibration and proprioception. Motor testing tone, strength, reflexes and coordination. Look for autonomic changes in colour, temperature, sweating and swelling. 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. Please complete this questionnaire by ticking one answer for each item in the 4 questions below. Interview Of The Patient Question 1: Does the pain have one or more of the following characteristics? 1: Burning Yes No 2: Painful Cold Yes No 3: Electric Shocks Yes No Question 2: Is the pain associated with one or more of the following symptoms in the same area? 4: Tingling Yes No 5: Pins and Needles Yes No 6: Numbness Yes No 7: Itching Yes No 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? 8: Hypoesthesia to touch Yes No 9: Hypoesthesia to prick Yes No Question 4: In the painful area, can the pain be caused or increased by: 10: Brushing ? Yes No
TO COLLATE: •Score 1 to each YES answer •Score 0 to each NO answer •If the score is 4 or higher then the pain is likely to be neuropathic pain. •If the score is less than 4 then the pain is unlikely to be neuropathic pain Ref : Bouhassira D, Attal N, Alchaar H, et al. "Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4)." Pain 114.1-2 (2005): 29-36. == 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 Bouhassira D, Attal N, Alchaar H, et al. "Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4)." Pain 114.1-2 (2005): 29-36. Neuropathic pain A management update Volume 42, No.3, March 2013 Pages 92-97 [1]
