Stratifying patients with peripheral neuropathic pain based on sensory profiles: algorithm and sample size recommendations

Vollert, Jan; Maier, Christoph; Attal, Nadine; Bennett, David L.H.; Bouhassira, Didier; Enax-Krumova, Elena; Finnerup, Nanna Brix; Freynhagen, Rainer; Gierthmühlen, Janne; Haanpää, Maija; Hansson, Per; Hüllemann, Philipp; Jensen, Troels Staehelin; Magerl, Walter; Ramirez, Juan D.; Rice, Andrew S.C.; Schuh‐Hofer, Sigrid; Segerdahl, Märta; Serra, Jordi; Shillo, Pallai Rappai; Sindrup, Soeren; Tesfaye, Solomon; Themistocleous, Andreas C.; Tölle, Thomas R.; Treede, Rolf‐Detlef; Baron, Ralf

doi:10.1097/j.pain.0000000000000935

Cited by 176 publications

(164 citation statements)

References 45 publications

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“…Thus, there is an increasing recognition that "one size does not fit all," and rather than having an agnostic approach (ie, blindly trying different therapies until one works), we should consider better clinical phenotyping and targeted therapies. 97 However, superficial clinical phenotyping in relation to symptomatology has not been shown to improve the response to therapy. 98 More detailed phenotyping using QST has shown that patients with an irritable nociceptor (IN) phenotype (n ¼ 31) compared to a non-IN phenotype (n ¼ 52) had a significantly greater response to oxcarbazepine and a reduced overall number needed to treat (NNT) (6.9 vs 3.9).…”

Section: Symptomatic Treatment Of Dpnmentioning

confidence: 99%

Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy

Iqbal

Azmi

Yadav

et al. 2018

Clinical Therapeutics

374

249

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Section: Symptomatic Treatment Of Dpnmentioning

confidence: 99%

Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy

Iqbal

Azmi

Yadav

et al. 2018

Clinical Therapeutics

374

249

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“…It is important to note that the pain part of a neuropathic problem has to be established using other pieces of the diagnostic armamentarium in addition. Additional diagnostic assessments, including quantitative sensory testing 47 , corneal confocal microscopy 48 and skin biopsy 49 , may be helpful for the clinician to diagnose the presence of a neuropathic pain component in rare but challenging cases (e.g. small-fibre neuropathy).…”

Section: We Do Not Know How To Screen For and Diagnose Mixed Pain Defmentioning

confidence: 99%

Current understanding of the mixed pain concept: a brief narrative review

Freynhagen

Parada²,

Calderón-Ospina

et al. 2019

Current Medical Research and Opinion

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Despite having been referenced in the literature for over a decade, the term "mixed pain" has never been formally defined. The strict binary classification of pain as being either purely neuropathic or nociceptive once left a good proportion of patients unclassified; even the recent adoption of "nociplastic pain" in the IASP Terminology leaves out patients who present clinically with a substantial overlap of nociceptive and neuropathic symptoms. For these patients, the term "mixed pain" is increasingly recognized and accepted by clinicians. Thus, an independent group of international multidisciplinary clinicians convened a series of informal discussions to consolidate knowledge and articulate all that is known (or, more accurately, thought to be known) and all that is not known about mixed pain. To inform the group's discussions, a Medline search for the Medical Subject Heading "mixed pain" was performed via PubMed. The search strategy encompassed clinical trial articles and reviews from January 1990 to the present. Clinically relevant articles were selected and reviewed. This paper summarizes the group's consensus on several key aspects of the mixed pain concept, to serve as a foundation for future attempts at generating a mechanistic and/or clinical definition of mixed pain. A definition would have important implications for the development of recommendations or guidelines for diagnosis and treatment of mixed pain.

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“…Currently there is a growing interest in characterizing the somatosensory profile of patients with chronic pain using both validated questionnaires and quantitative sensory testing (QST) . This may not only allow us to subgroup patients based on underlying mechanisms but also helps us to identify suitable targets for treatment and perhaps might help us differentiate responders from non‐responders .…”

Section: Introductionmentioning

confidence: 99%