Diagnosis Of Neuropathic Pain Research Articles

Chinese expert consensus on the surgical treatment of neuropathic pain by the spinal cord dorsal root entry zone

In order to promote the standardization of the treatment of neuropathic pain by spinal dorsal root entry surgery, alleviate the pain of certain specific neuropathic pain patients, and improve their quality of life and survival, experts with experience in neuropathic pain and spinal dorsal root entry surgery were organized by Functional Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association and Functional Neurosurgery Expert Committee of Chinese Congress of Neurological Surgeons to write this consensus. Based on a systematic review and summary of literature and clinical evidence at home and abroad, this consensus discusses the diagnosis and drug treatment of neuropathic pain, clinical application of, spinal dorsal root entry surgery the selection of patients receiving surgery of dorsal root entry zone, preoperative examination, surgical procedures, postoperative management, and the prevention and management of postoperative complications, and forms 12 recommended recommendations, providing reference and guidance for clinical work on the treatment of neuropathic pain through spinal dorsal root entry surgery.

Application and accuracy of the EAPC/IASP diagnostic algorithm for neuropathic cancer pain and quantitative sensory testing profile in patients with pain due to cancer.

Better diagnosis and treatment of neuropathic cancer pain (NcP) remains an unmet clinical need. The EAPC/IASP algorithm was specifically designed for NcP diagnosis; yet, to date, there is no information on its application and accuracy. Our aim was to determine the accuracy of the EAPC/IASP algorithm compared with the Neuropathic Special Interest Group grading system (gold standard) and to describe patients' sensory profile with quantitative sensory testing (QST). This is a cross-sectional observational study conducted in a palliative care and pain outpatient clinic. Patients with cancer pain intensity ≥3 (numerical rating scale 0-10) were eligible. The palliative care physician applied the EAPC/IASP algorithm as a grading system to diagnose probable or definite NcP, and an independent investigator applied the gold standard and performed the QST. Sensitivity and specificity of the EAPC/IASP algorithm were measured in comparison with the gold standard results. Kruskal-Wallis and unequal variance independent-samples t tests were used to compare the QST parameters in patients with and without NcP. Ninety-eight patients were enrolled from August 2020 to March 2023. Sensitivity and specificity for the EAPC/IASP algorithm were 85% (95% CI 70.2-94.3) and 98.3% (95% CI 90.8-100), respectively. Patients with NcP in contrast to patients without NcP showed cold hypoesthesia (P = 0.0032), warm hypoesthesia (P = 0.0018), pressure hyperalgesia (P = 0.02), and the presence of allodynia (P = 0.0001). The results indicate a good performance of the EAPC/IASP algorithm in diagnosing NcP and the QST discriminated well between patients with and without NcP.

An overview of diagnosis and assessment methods for neuropathic pain

Neuropathic pain, defined as pain arising as a consequence of a lesion or disease affecting the somatosensory nervous system, requires precise diagnostic assessment. Different diagnostic tools have been devised for the diagnosis of neuropathic pain. This review offers insights into the diagnostic accuracy of screening questionnaires and different tests that investigate the somatosensory nervous system, in patients with suspected neuropathic pain. Thus, it illustrates how these tools can aid clinicians in accurately diagnosing neuropathic pain.

Evaluation of peripheral nerve injury according to the severity of damage using 18F-FDG PET/MRI in a rat Model of sciatic nerve injury

ABSTRACT Objectives We ascertained that the PET scan may be a valuable imaging modality for the noninvasive, objective diagnosis of neuropathic pain caused by peripheral nerve injury through the previous study. This study aimed to assess peripheral nerve damage according to severity using18F-FDG PET/MRI of the rat sciatic nerve. Methods Eighteen rats were divided into three groups: 30-second (G1), 2-minute (G2), and 5-minute (G3) crushing injuries. The severity of nerve damage was measured in the third week after the crushing injury using three methods: the paw withdrawal threshold test (RevWT), standardized uptake values on PET (SUVR), and intensity analysis on immunohistochemistry (IntR). Results There were significant differences between G1 and G3 in both SUVR and IntR (p = 0.012 and 0.029, respectively), and no significant differences in RevWT among the three groups (p = 0.438). There was a significant difference in SUVR (p = 0.012), but no significant difference in IntR between G1 and G2 (p = 0.202). There was no significant difference between G2 and G3 in SUVR and IntR (p = 0.810 and 0.544, respectively). Discussion Although PET did not show results consistent with those of immunohistochemistry in all respects, this study demonstrated that PET uptake tended to increase with severe nerve damage. If this research is supplemented by further experiments, PET/MRI can be used as an effective diagnostic modality.

Corneal Neuropathic Pain: A Patient and Physician Perspective.

Corneal neuropathic pain (CNP) is a debilitating condition characterized by pain in the absence of a noxious stimulus. Symptoms such as ocular stinging, burning, photophobia, irritation, and a deep aching pain can be severe despite a seemingly normal ocular surface on examination. CNP may develop due to either peripheral or central sensitization. Peripheral sensitization develops due to aberrant regeneration of corneal nociceptors and nerve fibers as a result of corneal injury or disease of peripheral corneal nerves. Whereas, central sensitization develops due to upregulation of excitatory neurotransmitters as a result of chronic inflammation, which leads to amplification of neuronal response to stimuli. Unfortunately, due to the disparity in severity of symptomology and the observable signs on examination, patients' symptoms are commonly thought to be "psychological" or "functional", and patients report feeling ignored and neglected. Additionally, diagnosis is often delayed which adversely affects patient outcomes. Research to date has focused on the scientific aspects of corneal neuropathic pain: its pathophysiology, epidemiology, investigations, and management. Research into the patient personal experience and the challenges faced by individual patients and their clinicians is lacking. We present the patient and physician perspective on the journey of both patients in order to provide insights into the challenges faced by patients and physicians in the diagnosis, assessment, and management of corneal neuropathic pain.

An assessment of the treatment of spinal cord stimulation: Postlaminectomy pain or neuropathic pain

Neuromodulation has a significant place, among the interventional methods, in the treatment of chronic pain. Spinal Cord Stimulation (SCS) is the most applied treatment method among neuromodulation methods. SCS procedure is a neuromodulation method used in the failed back surgery syndrome, neuropathic pain, and cancer pain. The 102 patients who applied SCS were included in the retrospective study from 2017-2022 in the University Algology Department. We asked about pain scores in line with visual analog scale degrees (VAS) before and after the SCS procedure, opioid use and compared the patient satisfaction with the procedure. We divided the patients into two groups as those with a diagnosis of post-laminectomy syndrome (Group 1) and those with a diagnosis of neuropathic pain (Group 2). VAS before SCS was 9.11±0.75 in Group 1 and 8.45±0.77 in Group two. After SCS, the decrease in pain intensity was much more distinct in post-laminectomy patients (Group 1), compared to the neuropathic pain patients (Group 2). The results were as follows: Group 1- 1.98±1.40, Group 2-4.08±0.71, p<0.001. The decrease in using analgesics was observed to be much more significant in Group 2. (P<0.05) Patient satisfaction was higher in Group 1 as well (p<0.05). We hold the opinion that post-laminectomy patients benefit more from the SCS procedure than neuropathic pain patients. We observed that the decrease both in pain intensity and the use of opioid analgesics was statistically and overwhelmingly distinct in post-laminectomy patients. According to the results of our study, we think that SCS is an effective and safe treatment method both for post-laminectomy and neuropathic pain patients.

Neuropathic ocular pain: What is it and what to do about it?

Ocular surface pain (OSP) is a nonspecific symptom that can have a tremendous impact on quality of life. Individuals use various descriptors to characterize OSP including “dryness”, “burning”, “grittiness”,” shooting”, “discomfort”, “tenderness” and/or “aching”, to name a few. As feeling your eyes is “an unpleasant sensory and emotional experience”, these descriptors fit under the International Association for the Study of Pain (IASP) definition of pain.” Oftentimes, OSP is chronic in nature, lasting >3 months, although the intensity of pain can wax and wane over time. Furthermore, OSP can occur spontaneously or be triggered by stimuli such as light, wind or temperature change. In the past, OSP was placed under the umbrella term “dry eye”, as tear film abnormalities are one cause of OSP. However, it is now understood that factors beyond tear and ocular surface abnormalities may drive OSP and it is necessary to identify and address all potential contributors to pain. In general, contributors can be split across two broad categories: nociceptive contributors, defined as pain that arises directly from tissue damage at the level of the ocular surface and neuropathic contributors, defined as pain caused by a lesion or disease within peripheral or central nerves that connect the ocular surface to the brain. Or, as is the case in many individuals, pain contributors can arise from a combination of these two entities. Given the multiple potential contributors to OSP, a standardized examination and multimodal approach is necessary. In this presentation, we discuss advances in the diagnosis and management of OSP, with a focus on the diagnosis and treatment of neuropathic ocular surface pain (NOP).

Shedding light on neuropathic pain: Current and emerging tools for diagnosis, screening, and quantification.

Ensuring the proper management of neuropathic pain is a contemporary challenge for professionals who care for patients with this type of pain. The estimated prevalence of neuropathic pain in Europe is 7%-8%. The objective of this study was to perform a non-systematic review on the diagnosis, screening, and quantification of neuropathic pain. For this purpose, a search was conducted of the PubMed/Medline, ScienceDirect, OVID, and SciELO databases for available evidence. The findings highlight the common occurrence of chronic neuropathic pain in clinical practice. However, diagnosing and managing this type of pain pose challenges due to its complexity and the individualized nature of cases. Precise diagnosis is crucial for effective management, involving therapeutic approaches that go beyond traditional pain treatments. It is noteworthy that until recent times, general questionnaires were utilized to assess neuropathic pain, lacking the ability to distinguish it from nociceptive pain or evaluate its broader impact on well-being. Biomarker pain panels hold promise in identifying treatable pain causes and evaluating treatment effectiveness. In conclusion, this review describes the diagnostic methods and tools for screening and quantifying neuropathic pain.

Application of PainDETECT in pediatric chronic pain: how well does it identify neuropathic pain and its characteristics?

Neuropathic pain (NP) arises from nerve damage or disease, and when not defined, it can impair function and quality of life. Early detection allows for interventions that can enhance outcomes. Diagnosis of NP can be difficult if not properly evaluated. PainDETECT is a NP screening tool developed and successfully used in adults. We evaluated the validity of painDETECT in a pediatric population. Adolescents and young adults (10-19 years old) completed painDETECT and quantitative sensory testing (QST), which assessed mechanical allodynia and hyperalgesia, common symptoms of NP. Pain diagnoses, including neuropathic pain (n = 10), were collected through documentation in the medical chart. Descriptive statistics were used to examine age, gender, pain diagnoses, and painDETECT scores. Kruskal-Wallis H tests were conducted to examine differences in QST results across painDETECT categorizations. Youth with chronic pain (N = 110, Mage = 15.08 ± 2.4 years, Nfemale = 88) and peers without pain (N = 55, Mage = 15.84 ± 3.9 years, Nfemale = 39) completed the painDETECT. The painDETECT scores for youth with pain (M = 12.7 ± 6.76) were significantly higher than those for peers without pain (M = 2.05 ± 2.41). PainDETECT demonstrated 80% sensitivity and 33% specificity in a pediatric population. Individuals who screened positively on the PainDETECT had significantly higher mechanical allodynia (M = 0.640 ± 0.994) compared with those who screened negatively (M = 0.186 ± 0.499; P = 0.016). PainDETECT demonstrated the ability to screen for NP, and QST mechanical allodynia results were consistent with a positive NP screen. Results of the study offer preliminary support for the ongoing assessment of the painDETECT as a brief, inexpensive, and simple-to-use screening tool for pediatric patients with primary pain complaints.

Investigational Pregabalin Effect on Sleep in Patients with Neuropathic Pain and Sleep Maintenance Disturbance: A Multicentric Study

Objective: Our goal is to research how Pregabalin affects sleep maintenance in a group of neuropathic pain patients. Method and Material: A cross-sectional study including a sample of 600 patients was carried out. Patients with a neuropathic pain diagnosis were selected from three hospitals in Gandhinagar. After a medical professional diagnosed the patients with neuropathic pain, they were given a detailed description of the study's approach and asked for their informed consent. Subjects who are open to participating in the study and meet the inclusion and exclusion requirements. The demographic baseline evaluation and PSQI score were completed during Visit-01. After Visit-01, patients began receiving Pregabalin. After approximately 30 days from the date of enrolment, the patient was being monitored. The PSQI score was evaluated 30 days later. The Independent Ethics Committee (IEC) approved the PSQI Questioner and Informed Consent form after reviewing them. SPSS was used to statistically analyze the data (p < 0.05). Results: To evaluate variations in the distribution of "sleep disturbances vs. Sleep maintenance" (PSQI), we looked at the PSQI by time point. By using two-tailed paired t-tests, PSQI were compared for baseline and intervention conditions. Pregabalin treatment pre- and post-treatment were shown to differ significantly. Discussion: Sleep disturbances are prevalent characteristics of neuropathic pain that are well-known and well-documented. Patients with Neuropathic Pain had statistically significant improvements in sleep maintenance in the current investigation. Conclusion: The data presented here show that Pregabalin improves sleep quality in patients being treated for neuropathic pain

Utilization of PROMIS Neuropathic Pain Quality for Detection and Monitoring Neuropathic Pain in Heel Pain Patients.

Diagnosis and management of neuropathic pain (NP) in foot and ankle patients remain challenging. We investigated the plausibility of using Patient-Reported Outcomes Measurement Information System (PROMIS) Neuropathic Pain Quality (PQ-Neuro) as an initial screening tool to detect NP and track the treatment effects. Patients with heel pain were prospectively recruited and grouped to no-NP, mild-NP, and severe-NP based on the initial PROMIS PQ-Neuro t scores. Pain Interference (PI), Physical Function (PF), and Self-Efficacy (SE) scores were evaluated at baseline, 30-day, and 90-day follow-up. Other factors such as age, smoking, body mass index (BMI), low back/neck pain, anxiety/depression, and medications were analyzed. Linear mixed modeling was used to assess the main effects of time and NP on PROMIS t scores, comparing minimal clinically important difference (MCID). Forty-eight patients with mean age of 52.4 years were recruited. Using the PROMIS PQ-Neuro as the assessment tool, 33 patients (69%) were detected to have NP at baseline-23 (48%) mild and 10 (21%) severe. BMI was the only independent factor associated with NP (P = .011). Higher baseline PQ-Neuro t score was significantly associated with higher follow-up PQ-Neuro (P < .001), PI (P = .005), and lower SE (P = .04) across time points. Patients with NP showed lower PF at baseline with significantly less improvement in PF (3 vs 9.9, P = .035) and did not meet MCID. Baseline PROMIS PQ-Neuro ≥46 was significantly associated with worse PI and SE across all time points, with less clinically significant improvements in PF. Prevalence of NP in heel pain patients was high. The PROMIS PQ-Neuro may serve as a valuable tool for detection of NP and guiding clinical treatment decision pathways for heel pain patients. Level III, prospective cohort study.

Relationship between Nontraumatic Shoulder Disorders and Neuropathic Pain: Retrospective Observational Analyses of Clinical Features and Background Factors.

Accurate identification of neuropathic pain is necessary for appropriate treatment; however, the relationship between nontraumatic shoulder disorders and neuropathic pain remains unknown. Therefore, this retrospective observational study aimed to investigate the relationship, features, background factors, and prevalence of neuropathic pain among patients with nontraumatic shoulder disorders. We evaluated 198 patients who visited our outpatient clinic, which specializes in shoulder disorders, from April 2015 to March 2016. The patients' age, sex, affected side, diagnosis, and pain duration were recorded, and the results of physical examination, including passive range of motion, impingement sign, and muscular strength assessments, were analyzed. The presence of neuropathic pain was assessed using the painDETECT questionnaire. Participants were divided into two groups according to the presence of neuropathic pain. Pain intensity was assessed using a visual analog scale, and the patient's mental status was assessed using the short-form McGill Pain Questionnaire and Hospital Anxiety and Depression Scale. The scores were compared between the groups. Neuropathic pain was observed in 7.6% of patients. The visual analog scale score for pain, short-form McGill Pain Questionnaire score, and Hospital Anxiety and Depression Scale score were significantly associated with the presence of neuropathic pain in the univariate analysis. Patient background factors and physical function were not associated with the presence of neuropathic pain. The prevalence of neuropathic pain in patients with frozen shoulder was 33.3%, which was significantly higher than that in patients with other shoulder disorders. The occurrence of neuropathic pain may aggravate pain in patients with nontraumatic shoulder disorders. Neuropathic pain was not a rare condition in patients with nontraumatic shoulder disorders, particularly in those with frozen shoulder. The coexistence of neuropathic pain cannot be determined from background factors or physical function. Accurate diagnosis of neuropathic pain is essential in patients with nontraumatic shoulder disorders.

Rehabilitation of children with Lyme arthritis

Background. Lyme disease is a common tick-borne infection. Untimely diagnosis and treatment lead to the chronicity of the process with the development of late lesions of various systems and organs and possible disability. The purpose of the study was to develop a program of rehabilitation measures for children with Lyme disease. Material and methods. The research was conducted on the basis of the Ternopil Regional Children’s Hospital. Twenty children, residents of the Ternopil region, who applied to the Ternopil Regio­nal Children’s Hospital for tick bites and, as a result, diagnosed Lyme arthritis, took part in the study. To assess the severity of pain, we used scales and questionnaires for the diagnosis of DN4 neuropathic pain. Laboratory and instrumental studies were performed such as evaluation of the level of malondialdehyde, diene conjugates, superoxide dismutase. Results. Clinical examination of tick-affected children with Lyme disease showed that the most common primary clinical manifestation is a typical skin lesion — erythema migrans. In case of arthritis, all children notice inflammatory changes and pain in the joints. As a result of the conducted studies, the activation of peroxidation in children with Lyme disease was detected (an increase in the level of malondialdehyde and a decrease in superoxide dismutase, diene conjugates). It was shown that combined therapy with the use of magnetic laser therapy leads to the normalization of lipid peroxidation. Conclusions. All children with Lyme arthritis have a pain syndrome of varying severity. In patients with Lyme disease, there is an increase in the activity of lipid peroxidation and a decrease in the functional capacity of the antioxidant defense system. Children who underwent traditional treatment for Lyme arthritis reported a partial normalization of lipid peroxidation as evidenced by a significantly decreased level of diene conjugates compared to controls. In the group of patients who underwent combined treatment for Lyme arthritis (antibacterial therapy + magnetic laser therapy), the activity of antioxidant defense was normalized. Combination of magnetic laser therapy with antibacterial therapy demonstrates an improvement of pain status and faster rehabilitation of children.

The quality of prison primary care: cross-sectional analyses of prison healthcare data in Northern England.

Prisoners have considerable health needs, are relatively high users of health care and often die prematurely. Prison healthcare research has typically focused on specific problems such as substance misuse, but 'routine' primary care has received less attention. Strong primary care systems are associated with better population outcomes. Identifying inappropriate variations in care will inform strategies to close gaps in health care and reduce preventable deaths. To explore variations in the quality of primary care for prisoners. We assessed achievement against 30 quality indicators examining different aspects of care in 13 prisons. We conducted repeated cross-sectional analyses of routinely recorded data from electronic health records across 2017-2020. Multi-level logistic regression models explored associations between indicator achievement and prison and prisoner characteristics. We found marked variations in achievement between different indicators and different prisons. Achievement ranged from 0·2% of people with epilepsy coded as seizure-free, to 93·8% of people with diabetes having blood pressure checks, in the preceding year. Achievement improved over three years for 11 indicators and worsened for six, including declining antipsychotic monitoring and rising opioid prescribing. Achievement varied between prisons, from 1·93-fold for prescribing of gabapentinoids with no coded diagnosis of neuropathic pain (Odds Ratio (OR) range 0·67 to 1·29) to 21,610-fold for medicine reconciliation (OR range 0·45 to 9724·5). Shorter lengths of stay were frequently associated with lower achievement. Some associations between ethnicity and achievement were identified. We found substantial scope for improvement and marked variations in quality which were largely unaltered after adjustment for prison and prisoner characteristics.

Efficacy of Lidocaine Infusion for Treatment of Chronic Neuropathic Pain: A Case Control Study

Background: Neuropathic pain is a type of chronic pain that is related to nerve damage and is defined by the International Association of Study of Pain (IASP) as “pain caused by a disease or lesion of the somatosensory nervous system”. It remains a challenging clinical problem as pain often can be quite severe and debilitating. The rationale of this study is to find out the efficacy of intravenous lidocaine infusion for neuropathic pain management in our population as there has been no study conducted in Pakistan for this purpose. As our country has a rather low-income population and cheaper options for treatment need to be explored. Objective: To determine the efficacy of lidocaine infusions of 3 mg/kg in managing the chronic neuropathic pain given at 0,1, 2 and 3 weeks in comparison to the placebo infusion. Study Design: Case control study. Settings: The study was conducted in the Sheikh Zayad Hospital Lahore Pakistan. Duration: July 2022 to December 2022. Methods: 100 outdoor patients fulfilling the inclusion and exclusion criteria were enrolled after taking informed written consent and were randomly allocated to Lidocaine group (A) 3 mg/kg, diluted in 50 ml normal saline and placebo group (B) 50 ml intravenously over 30 minutes. The Lidocaine group was injected with lidocaine, intravenously over 30 minutes once a week for 4 weeks. Patients with established diagnosis of neuropathic pain, adults of both genders, age above 18 years were enrolled in this study. Their pain severity was recorded using Numerical rating scale (NRS). The data of both groups was recorded in predesigned proforma and efficacy was also noted as labelled as Yes/No for two points; 1: Decrease in pain score by at least 2 out of 10 and 2: Decrease in oral analgesics intake. Results: There were 50 patients in group A and B with the mean age of 53.82 years and 54.4 years respectively. Patients in group A who received an intravenous infusion of lidocaine reported less severe pain and fewer instances of breakthrough pain. No statistically significant difference (P&gt;0.05) was discovered between NRS ratings before and after infusions in the control group despite the fact that several patients reported lower pain intensity after the infusion. The quantity of opioid used was determined for the Lidocaine and Placebo groups. Opioid in the placebo group was 0.472–0.572 g per patient, but in the Lido group it was only 0.1–0.2 g per patient which is significantly different from placebo group (p=0.0021). Conclusion: Lidocaine intravenous infusion (3 mg/kg daily for 4 weeks) improved short-term results of therapy, decreased the need for analgesic medication, and shortened pain score without causing major adverse effects.

Peripheral neuropathy and neuropathic pain in the elderly

Neuropathic pain is a common symptom in the elderly and tends to increase according to the frequency of related underlying disease. In older patients, cognitive decline and accompanying medical conditions may make early diagnosis difficult. Therefore, a detailed history taking, neurological examination, and laboratory tests should be performed. Diabetic peripheral neuropathy, entrapment neuropathy, radiculopathy, postherpetic neuralgia, and chemotherapy-induced peripheral neuropathy are the major causes of peripheral neuropathy in the elderly. When treating elderly patients, the dose of drug should be adjusted in consideration of its side effects. An accurate diagnosis and treatment of neuropathic pain is essential to improve the quality of life of elderly patients.

Low-Dose Naltrexone (LDN) for Chronic Pain at a Single Institution: A Case Series.

Low-dose naltrexone (LDN) has increased in popularity as a non-opioid medication that may decrease chronic pain symptoms. LDN is most commonly used to treat fibromyalgia, complex regional pain syndrome (CRPS), and painful diabetic neuropathy. Other studies suggest that LDN provides general symptom reduction in inflammatory conditions such as Crohn's disease and multiple sclerosis. We reviewed our experience with patients to whom we have prescribed LDN to see what types of painful conditions were most responsive to LDN in our patient population. Charts from patients who came to the Pain Center between 2014 and 2021 were reviewed. Of the n = 137 patients who were prescribed LDN, 44% had no evidence of ever filling the prescription, and 4.4% of the responses were not charted. Of the remaining who took LDN (n = 70), 64% had some relief and were designated as 'Responders'. The most common pain diagnosis was neuropathic pain which, when added to the diagnosis of complex regional pain syndrome, accounted for 51% of responders to LDN. Patients who experienced greater than 50% pain relief from LDN were more likely to have the diagnosis of neuropathic pain or complex regional pain syndrome (p = 0.038, Fisher's Exact Test). There was a significant difference in the diagnosis of patients who responded to LDN. Patients with spondylosis were much less likely to respond to LDN when compared with other diagnoses (p = 0.00435, Chi-Square Test). Patients with all types of neuropathic pain, including CRPS, were significantly more likely to have pain relief from LDN than patients with spondylosis (p=0.018). The diagnosis of spondylosis was more often associated with a lack of response to LDN than any other diagnosis. Patients may need to have a trial of several weeks before analgesic effects are seen with LDN.

Factors Associated With Guideline-Concordant Pharmacological Treatment for Neuropathic Pain Among Breast Cancer Survivors

PurposeTo identify factors associated with receiving guideline-concordant treatment among breast cancer survivors with neuropathic pain. Materials and MethodsA retrospective case-control study was conducted using the SEER-Medicare linked database. We included female breast cancer survivors diagnosed with non-metastatic breast cancer (stages 0-III) between 2007 and 2015 who developed treatment-related neuropathic pain during their survivorship period. Guideline-concordant treatment was defined based on NCCN guidelines. Factors associated with receiving guideline-concordant treatment were assessed using multivariable logistic regression and backward selection was used to identify potential associated factors. ResultsAround 16.7% of breast cancer survivors in the study developed a neuropathic pain condition. The mean time to develop neuropathic pain was 1.4 years after beginning adjuvant treatment. On average, patients who developed neuropathic pain and received guideline-concordant treatment did so at 2.4 months after their neuropathic pain diagnosis. We found that survivors that are black and of other races were less likely to receive guideline-concordant treatment for breast cancer treatment-related neuropathic pain. Whereas survivors with diabetes, mental health disorders, hemiplegia, prior continuous opioid use, benzodiazepine use, nonbenzodiazepine CNS depressant use, or antipsychotic medication use were less likely to receive guideline-concordant treatment. ConclusionThis study suggests that minority races, prior medication use, and comorbid conditions are associated with guideline-concordant treatment among breast cancer survivors with neuropathic pain. These findings warrant attention towards minority races to prescribe them guideline-concordant treatment as well as caution when prescribing concurrent pain medications to survivors with comorbidities and prior medication use.

The sensitivity and specificity of using the McGill pain subscale for diagnosing neuropathic and non-neuropathic chronic pain in the total joint arthroplasty population

BackgroundThe purpose of this study was to describe the diagnostic performance of the Neuropathic Pain Subscale of McGill [NP-MPQ (SF-2)] and the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire in differentiating people with neuropathic chronic pain post total joint arthroplasty (TJA).MethodsThis study was a survey of a cohort of individuals who had undergone primary, unilateral total knee, or hip joint arthroplasty. The questionnaires were administered by mail. The time interval from operation to the completion of the postal survey varied from 1.5 to 3.5 years post-surgery. Receiver Operating Characteristic (ROC) analysis was used to assess the overall diagnostic power and determine the optimal threshold value of the NP-MPQ (SF-2) in identification of neuropathic pain.ResultsS-LANSS identified 19 subjects (28%) as having neuropathic pain (NP), while NP-MPQ (SF-2) subscale identified 29 (43%). When using the S-LANSS as the reference standard, a Receiver Operating Characteristic (ROC) analysis for NP-MPQ (SF-2) had an area under the curve of 0.89 (95% CI: 0.82, 0.97); a cut off score of 0.91 NP-MPQ (SF-2) maximized sensitivity (89.5%) and specificity (75.0%). Correlation between the measures was moderate (r = 0.56; 95% CI: 0.40, 0.68).ConclusionThese finding suggest some conceptual overlap but some variability in diagnosis of NP which may relate to scale-tapping into different dimensions of the pain experience, or the different scoring metrics.

Multidisciplinary consensus on the diagnosis and treatment of peripheral and localized neuropathic pain in Mexico

Multidisciplinary consensus on the diagnosis and treatment of peripheral and localized neuropathic pain in Mexico