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.

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.