Identification of neuropathic pain in patients with neck/upper limb pain: Application of a grading system and screening tools

Early identification of neuropathic pain (NeP) is crucial, as NeP in particular requires targeted management. As no ‘‘gold standard’’ exists for the diagnosis of NeP, a grading system with different levels of certainty about the presence of NeP (no, possible, probable, definite) has been developed by the Neuropathic Pain Special Interest Group (NeuPSIG) of the IASP.

This study evaluated this system in patients with neck/upper limb pain with a suspected nerve lesion. 82 patients (54%) reported the neck/trapezius/ scapula/shoulder area as their main area of pain. 2 validated questionnaires were used to assess neuropathic pain symptoms: LANSS (Bennett 2001) and the PD-Q (Freynhagen 2006) in identifying NeP in this patient cohort.

The results of this study showed that LANSS and PD-Q have a diagnostic accuracy limitation for the identification of NeP, as both failed to identify a large number if patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD-Q sensitivity 64%, specificity 62%).

In conclusion, this approach might not be feasible in primary care settings for patients with complex pain presentations due to the time and specific expertise required for classification. NeP screening tools should always be used in conjunction with comprehensive clinical assessment of the patient and should not replace clinical judgment. > From: Tampin et al., Pain 154 (2013) 2813-2822.

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