International Association For The Study Of Pain Research Articles

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

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.

СУЧАСНЕ СТАВЛЕННЯ ДО УЧАСТІ МЕДИЧНИХ СЕСТЕР У ВИРІШЕННІ ПРОБЛЕМИ ЛІКУВАННЯ ПОСТРАЖДАЛИХ ВІД НАСЛІДКІВ АВАРІЇ НА ЧОРНОБИЛЬСЬКІЙ АТОМНІЙ ЕЛЕКТРОСТАНЦІЇ ТА МЕТОДОЛОГІЇ ДІАГНОСТИКИ ТА ЛІКУВАННЯ БОЛЮ У ЦІЄЇ КАТЕГОРІЇ ХВОРИХ

Міжнародна асоціація з вивчення болю (IASP) дає йому таке визначення: це неприємне сенсорне і емоційне переживання, пов'язане з дійсним або потенційним пошкодженням тканини. Біль є однією з найпоширеніших скарг, проте являє собою феномен, найбільш важкий для уточнення. Тривалий час він розглядався виключно як проблема лікаря і пацієнта, проте протягом останнього часу у боротьбі з ним значне місце стали займати медичні сестри. Для досягнення позитивного ефекту у цьому необхідно користуватись обґрунтованими стандартами та схемами діагностики і лікування.

Pain Comorbidities: Understanding and Treating the Complex Patient Giamberardino Maria Adele and Jensen Troels Staechelin Pain Comorbidities: Understanding and Treating the Complex Patient518pp £55 IASP (International Association for the Study of Pain) 9780931092923 0931092922

This book was written by credible authors who are all experts in their fields. A lengthy and expensive tome, it would be a useful addition to any library, but its cost probably precludes individual ownership.

Is birthing pain the trigger of postpartum depression? A commentary on “Childbirth pain and postpartum depression”

In 2007 the International Association for the Study of Pain (IASP) launched the campaign “Real Women, Real Pain”; 2007e2008 was declared as the “Global Year Against Pain” inWomen. By then it was recognized that 90% of women experience severe/unbearable labor pain, and that one very real consequence to labor pain was psychological: “Long-term emotional stress with potential adverse consequences on maternal mental health and family relationships” [1]. One year later Eisenach and his colleagues published their seminal data on the association between acute pain and postpartum depression [2]. Eisenach conducted a multicentre study across North America andWestern Europe, recruiting 1288 women after vaginal and cesarean delivery (CD). The reported combined incidence of acute pain 36 h after deliverywas 10.6%, and persistent pain at 8 weeks was 9.8%. Multivariable regression revealed a threefold increased risk of postpartum depression (PPD) in the presence of acute pain. Rates of persistent pain after cesarean delivery (PPCD) are subject to debate [3]. At the lower end, Eisenach et al. reports PPCD as 1.8% at 6months decreasing to 0.3% at 12months [4]. At the other end of the spectrum, 20% of PPCD is reported 2 years after CD for breech lie [5]. Other studies report rates between 6 and 18% beyond 6 months postpartum [6e8]. Although vaginal birth is one of the

A report from the first regional pain medicine symposia in East, Central and Southern African region. (ECSA-R)-"The Rhino Model in Pain Education in Africa".

The 1st Regional pain medicine symposia were held between the 14th and 18th of November 2011 in 3 cities (Nairobi, Mombasa and Dar-es-salaam), across 2 countries, Kenya and Tanzania. It was funded by the International Association for the Study of Pain (IASP), through the IASP developing country education grant for 2011 and The Aga Khan University Hospital Nairobi (AKUHN). It was organized by faculty from the Pain Management Unit (PMU) AKUHN. The Pain medicine educators were from PMU, AKUHN and from Specialists in Pain International Network (SPIN). The aims of the symposia were to introduce the Rhino model concept, the theoretical and clinical concepts of pain medicine, as well as create awareness and stimulate an interest in pain medicine education and pain research in ECSA region. At each of the 3 different locations, the same topics and workshops were presented by the speakers, thus ensuring uniformity of the message delivered.

Classification of facial pain: a 13-year population-based study

Introduction: Accurate diagnosis and classification of facial pain is critical for assigning surgical treatment, avoiding misdirected interventions and studying outcomes. We conducted a population-based longitudinal study of patients with facial pain and compared diagnostic classification systems. Methods: Medical records for all Manitobans presenting to our centre with a primary complaint of facial pain from 2001 to 2013 were reviewed. We then applied diagnostic criteria from the International Classification of Headache Disorders (IHS-3), the International Association for the Study of Pain (IASP) and Burchiel’s system for comparisons. Results: There were 534 patients with facial pain (3.4/100,000/year) and two-thirds of these had conditions potentially amenable to neurosurgical interventions. Our most common diagnoses were typical trigeminal neuralgia(50%), atypical trigeminal neuralgia(7%), idiopathic trigeminal neuropathy(7%), idiopathic facial pain(11%); average ages were 65±14(22-99), 60±18(32-86), 55±16(28-83) and 48±12(28-82) with a female proportion of 55%, 59%, 65% and 80%, respectively. Other classification systems included no criteria for idiopathic trigeminal neuropathy. The classifications of “trigeminal neuralgia type-1 and type-2” did not differentiate between surgical and non-surgical candidiates. Conclusion: Published classification systems of facial pain have differing criteria for diagnosis of trigeminal neuralgia and none defines a large group with idiopathic trigeminal neuropathy. This may lead to considerable variability in determinations of potential surgical candidates and comparing outcomes of treatment.

Comparing the DN4 tool with the IASP grading system for chronic neuropathic pain screening after breast tumor resection with and without paravertebral blocks: a prospective 6-month validation study.

Investigating protective strategies against chronic neuropathic pain (CNP) after breast cancer surgery entails using valid screening tools. The DN4 (Douleur Neuropathique en 4 questions) is 1 tool that offers important research advantages. This prospective 6-month follow-up study seeks to validate the DN4 and assess its responsiveness in screening for CNP that satisfies the International Association for the Study of Pain (IASP) definition and fulfills its grading system criteria after breast tumor resection with and without paravertebral blocks (PVBs). We randomized 66 females to standardized general anesthesia and sham subcutaneous injections, or PVB and total intravenous anesthesia. The 6-month CNP risk was assessed using the IASP grading system and the DN4 screening tools. We evaluated the DN4 sensitivity, specificity, and responsiveness in capturing the impact of PVB on the CNP risk relative to the IASP grading system. Data from 64 patients showed similar demographic characteristics in both groups. Twenty patients in both groups met the grading system CNP criteria; among these, 18 patients also met the DN4 CNP criteria. Furthermore, 15 patients in both groups did not meet the grading system CNP criteria; among these, 9 patients also did not meet the DN4 CNP criteria. Therefore, the sensitivity and specificity of the DN4 were estimated at 90% and 60%, respectively. Both screening tools suggested that PVB reduced the 6-month CNP risk. Our results suggest that the DN4 can reliably identify CNP at 6 months after breast tumor resection and detect the preincisional PVB effect on the risk of developing such pain.

Somatoform disorders in litigation: causation and prognosis

Orthopaedic experts will be familiar with litigated accidents in which there is a relatively minor soft-tissue injury that does not explain the persistent severity of pain and the ensuing marked disability. They will also usually be aware that 90% of patients with chronic low back pain do not have any reliable evidence of a significant structural causative defect or injury.1 The International Association for the Study of Pain (IASP) definition of pain emphasises the importance of psychological factors in its perception: pain is regarded as an unpleasant sensory and emotional experience. Many people report pain in the absence of tissue damage or any likely pathophysiological cause and this usually happens for psychological reasons. Pain is always a psychological state.2 This article examines how claimants with medically unexplained pain may be diagnosed by psychiatrists, and the implications for their treatment and prognosis are discussed. The diagnosis of psychiatric disorders is generally made with reference to the current edition of the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association3 or the International Classification of Diseases published by the World Health Organization.4 Both of these classification systems are recognised by the British courts and neither is regarded as more valid. However, the relatively new diagnosis of a Somatic Symptom Disorder3 is of little utility in personal injury litigation. The accompanying text in the DSM states that “the reliability of determining a somatic symptom is medically unexplained is limited” and on this basis the presence or absence of a medical explanation is irrelevant to the diagnosis. However, in court, the psychiatrist that continued to entertain a probable persisting medical cause would be acting outside their area of expertise if, for example, an orthopaedic expert had already excluded a physical cause. The Somatic Symptom Disorder diagnosis is …

A classification of chronic pain for ICD-11.

A classification of chronic pain for ICD-11.

Complex regional pain syndrome: time to study the supraspinal role?

The International Association for the Study of Pain (IASP) defines complex regional pain syndrome (CRPS) as a spontaneous or stimulus-induced pain that is disproportionate to the inciting event and is accompanied by a wide variety of autonomic and motor disturbances, in highly variable combinations. As noted in the definition, there are a number of possible causes for CRPS. These include tissue damage, nerve damage, casting, traumas, fractures, burns, frostbites, strokes, and other non-identifiable causes. The symptoms of reflex sympathetic dystrophy that do not accompany nerve damage are generally classified as CRPS type 1, while those accompanying nerve damage - such as causalgia - are classified as CRPS type 2. Although various reports have suggested different incidence rates, the condition has generally been found in 20-30 cases per 100,000 persons; the incidence rate of CRPS type 2 is reported to be 0.82 cases per 100,000 persons.

Immune activation and autoimmunity in chronic pain conditions and response to immunoglobulin G.

Immune activation and autoimmunity in chronic pain conditions and response to immunoglobulin G.

Classification of neuropathic pain in cancer patients: A Delphi expert survey report and EAPC/IASP proposal of an algorithm for diagnostic criteria

Neuropathic pain (NP) in cancer patients lacks standards for diagnosis. This study is aimed at reaching consensus on the application of the International Association for the Study of Pain (IASP) special interest group for neuropathic pain (NeuPSIG) criteria to the diagnosis of NP in cancer patients and on the relevance of patient-reported outcome (PRO) descriptors for the screening of NP in this population. An international group of 42 experts was invited to participate in a consensus process through a modified 2-round Internet-based Delphi survey. Relevant topics investigated were: peculiarities of NP in patients with cancer, IASP NeuPSIG diagnostic criteria adaptation and assessment, and standardized PRO assessment for NP screening. Median consensus scores (MED) and interquartile ranges (IQR) were calculated to measure expert consensus after both rounds. Twenty-nine experts answered, and good agreement was found on the statement “the pathophysiology of NP due to cancer can be different from non-cancer NP” (MED=9, IQR=2). Satisfactory consensus was reached for the first 3 NeuPSIG criteria (pain distribution, history, and sensory findings; MEDs⩾8, IQRs⩽3), but not for the fourth one (diagnostic test/imaging; MED=6, IQR=3). Agreement was also reached on clinical examination by soft brush or pin stimulation (MEDs⩾7 and IQRs⩽3) and on the use of PRO descriptors for NP screening (MED=8, IQR=3). Based on the study results, a clinical algorithm for NP diagnostic criteria in cancer patients with pain was proposed. Clinical research on PRO in the screening phase and on the application of the algorithm will be needed to examine their effectiveness in classifying NP in cancer patients.

Complex Regional Pain Syndrome.

Koh, Thuan-Tzen MBBS, BMedSci1; Daly, Anne DClinPhysio1; Howard, William MBBS, FANZCA1; Tan, Chong MBBS, FANZCA1; Hardidge, Andrew MBBS, FRACS (Orth), FAOrthA, PGDip(Mgmt)1 Author Information

Experiencia en la aplicación de la acupuntura en el dolor neuropático posquirúrgico

The paper presents the clinical management of a patient with an anal abscess which, after an unsuccessful treatment with antibiotics and anti-inflammatory drugs which ends up with the formation of a fistula, undergoes a partial fistulectomy surgery. During the immediate postsurgical period, paresthesias radiating to the lower limbs, allodynia, as well as limitations in her daily life and psychosocial affection appear. The diagnosis is peripheral neuropathic pain (NP) secondary to surgery. The implemented treatment includes pharmacological treatment and acupuncture. The treatment of the NP is considered to be extremely difficult, particularly when other associated comorbidity symptoms appear, which happens usually. The prevalence of NP is estimated to be around 5-7.5% in Europe according to the International Association for the Study of Pain (IASP). Currently, no clear consensus exists on the optimal management of NP, probably due to the lack of agreement on diagnostic protocols and to the co-existence of neuropathic, nociceptive, and sometimes, idiopathic pain in the same patient.

Guidelines for recognition, assessment and treatment of pain: WSAVA Global Pain Council members and co-authors of this document:.

Karol Mathews DVM DVSc DACVECC (Canada) Peter W Kronen Dr Vet Med, DVM DECVAA (Switzerland) Duncan Lascelles BSc BVSc PhD DSAS DECVS DACVS MRCVS (USA) Andrea Nolan MVB DVA PhD DECVAA DECVPT MRCVS (UK) Sheilah Robertson BVMS (Hons) PhD DACVAA DECVAA DECAWBM (WSEL) DACAW MRCVS (USA) Paulo VM Steagall MV MS PhD DACVAA (Brazil/Canada) Bonnie Wright DVM DACVAA (USA) Kazuto Yamashita DVM MS PhD DJCVS (Japan)

Pain treatment facilities: do we need quantity or quality?

Chronic pain patients referred to a pain treatment facility have no guarantee that they will receive a proper diagnostic procedure or treatment. To obtain information about organizational aspects of pain treatment facilities and the content of their daily pain practice, we performed a questionnaire survey. The aim of the study was to evaluate the amount of pain treatment facilities, the content of organized specialized pain care and adherence to the criteria of the internationally accepted guidelines for pain treatment services. The University Pain Centre Maastricht in the Department of Anaesthesiology and Pain Management at Maastricht University Medical Centre developed a questionnaire survey based on the Recommendations for Pain Treatment Services of the International Association for the Study of Pain (IASP). The questionnaire was sent to the medical boards of all hospitals in the Netherlands (n=94). The response rate was 86% (n=81). Of all hospitals, 88.9% (n=72) reported the provision of organized specialized pain care, which was provided by a pain management team in 86.1% (n=62) and by an individual specialist in 13.9% (n=10). Insight was obtained from pain treatment facilities in five different domains: the organizational structure of pain management, composition of the pain team, pain team practice, patient characteristics, and research and education facilities. Although 88.9% of all hospitals stated that organized specialized pain care was provided, only a few hospitals could adhere to the criteria for pain treatment services of the IASP. The outcome of the questionnaire survey may help to define quality improvement standards for pain treatment facilities.

Validation of the Greek Version of the DN4 Diagnostic Questionnaire for Neuropathic Pain.

The Douleur Neuropathique 4 questionnaire (DN4) was developed by the French Neuropathic Pain Group and is a simple and objective tool, primarily designed to screen for neuropathic pain. The aim of our study is to validate the DN4 in the Greek language. The study was set up as a prospective observational study. Two pain specialists independently examined patients and diagnosed them with neuropathic, nociceptive, or mixed pain, according to the International Association for the Study of Pain (IASP) definitions. A third and a fourth physician administered the DN4 questionnaire to the patients. Out of the 237 patients who met our inclusion criteria and had identical diagnoses regarding the type of pain, 123 were diagnosed with neuropathic, 59 with nociceptive, and 55 with mixed pain. Among patients with identical diagnoses of neuropathic or nociceptive pain, using a receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.92. A cutoff point of equal or greater than 4 resulted in a sensitivity of 93% and a specificity of 78%. Among patients suffering from pain with neuropathic element (neuropathic or mixed pain) or pain with no neuropathic element (nociceptive pain), using a ROC curve analysis, the AUC was 0.89. A cutoff point of equal or greater than 4 resulted in a sensitivity of 89% and a specificity of 78%. The Greek version of DN4 is a valid tool for discriminating between neuropathic and nociceptive pain conditions in daily practice.

Complex regional pain syndrome: recent updates

Complex regional pain syndrome (CRPS) may be defined as a painful and disabling disorder affecting one or more extremities showing signs of vasomotor (relating to the constriction and dilatation of blood vessels), sudomotor (stimulation of sweat glands), inflammatory, and trophic changes (changes brought about in tissues from interruption or destruction of nerve, blood supply or both) in the affected extremity. CRPS can occur after even trivial injury and, on occasion, can develop spontaneously. It was first described as a spectrum of symptoms during the American Civil War by Silas Weir Mitchell and colleagues in their book entitled Gunshot Wounds and Other Injuries of Nerves, and named it causalgia. The gamut of symptoms stretches from a self-limiting mild condition to a severe, debilitating condition affecting the quality of life and having a high impact on activity. Owing to the varied manifestation, the patient can present to any specialty be it orthopaedics, rheumatology, neurology, dermatology, or pain medicine. Pain is an early presenting feature and can be the most prominent of symptoms. A high index of suspicion is needed as early diagnosis and treatment may prevent the progression of symptoms and prevent disability. It has been known by many names in the past, including reflex sympathetic dystrophy, algodystrophy, algoneurodystrophy, Sudeck’s dystrophy, and causalgia. In 1994, the International Association for the Study of Pain (IASP) came up with a standardized set of criteria to diagnose CRPS. Until then, numerous different diagnostic and clinical criteria were used. As IASP criteria lacked specificity, a new set of diagnostic criteria were adapted at a closed conference of leading experts from around the world in the Fall of 2004 in Budapest, Hungary—these were called the ‘Budapest criteria’ (Table 1). The Budapest criteria were compared with the former IASP criteria and found to have a higher specificity while maintaining sensitivity, and were validated. Clinical presentation

Female chronic pelvic pain is common and complex

Chronic pelvic pain is simply long-term pain in the structures of natomic pelvis. This iswhere the simplicity stops. Since the female elvis contains organs and structures belonging to gynaecologial, gastrointestinal, urological andmusculoskeletal organ systems nyone or several of these organ systemsmay be involved in pelvic ain. Pain can be related to a specific diagnosis like endometriosis, nfection or tumour, but in other cases no specific pathology can e demonstrated. In some cases pain can be independent of the bvious pathology. The IASP (International Association for the Study of Pain) definiion of chronic pelvic pain is more limited stating that the pain has pparently gynaecological origin but for which no definitive lesion r cause can be found [1]. However, gynaecological disorders are ot the sole aetiologies behind chronic pelvic pain. Urinary and gasrointestinal aetiologies are common causes for chronic pelvic pain. n addition, patients with chronic pelvic pain often report concurent symptoms like irritable bowel syndrome or interstitial cystitis 2,3]. Large portions of patientswith chronic pelvic pain report pain n several areas, as well as chronic pain in other body parts [3–5]. hronic pelvic pain can be considered as a chronic pain syndrome long with chronic pain syndromes in other parts of the body with hanges in pain modulatory mechanisms. Due to localization of the pelvic pain delicate psychological ssues are involved and should be considered in research as well s in clinical management of the condition. Associated psychosoial problems cause further suffering and decrease in quality of life or these patients. On the other hand, psychological disturbances hould not be regarded as primary aetiological factors for chronic elvic pain.

Selected Reports From the 8th European Pain Congress; Pain in Europe VIII

ABSTRACTThe European Federation of IASP (International Association for the Study of Pain) Chapters (EFIC) held its 8th EFIC Congress in Florence, Italy, on October 9 to 12, 2013. Over 4000 clinicians and basic scientists attended the interdisciplinary congress. This report summarizes a range of selected presentations from the Congress. It is adapted from the authors’ abstracts of their work.