Neuropathic pain: an updated grading system for research and clinical practice

Abstract

The redefinition of neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system,” which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the “definite” level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research.

The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method

“…As was also noticed during the panel discussions, some of these may need further refinement. This is particularly true for the concept of neuropathic (versus nociceptive or mechanical) pain for which there is currently much debate on its precise nature [14,[42][43][44][45] and role in the diagnostic evaluation and treatment choice for patients with PPSS [12-14, 46, 47]. Further research may also consider the inclusion of additional somatic variables, potentially relevant to treatment choice, such as sagittal balance [15,16].…”

The 5% Lidocaine-Medicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use

“…Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system” [35, 36]. Population-based surveys in the United Kingdom and France have found the prevalence of pain with predominantly neuropathic characteristics to be 8% and 6.9%, respectively [37, 38].…”

Food-Derived Natural Compounds for Pain Relief in Neuropathic Pain

“…The International Association for the Study of Pain (IASP) defines neuropathic pain as pain caused by a lesion or disease of the somatosensory nervous system, which causes unpleasant and abnormal sensation (dysesthesia), an increased response to painful stimuli (hyperalgesia), and pain in response to a stimulus that does not normally provoke pain (allodynia) [1, 2]. This definition of neuropathic pain distinguishes it from other types of pain, including musculoskeletal pain, by restricting its extent to the somatosensory nervous system.…”