Leeds Assessment Of Neuropathic Symptoms And Signs Research Articles

The EAN-NeuPSIG guideline on the diagnosis of neuropathic pain-asummary

In this joint guideline of the scientific societies and working groups mentioned in the title, evidence-based recommendations for the use of screening questionnaires and diagnostic tests in patients with neuropathic pain were developed. The systematic literature search and meta-analysis yielded the following results: Of the screening questionnaires, Douleur Neuropathique en 4Questions (DN4), I‑DN4 (self-administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received astrong recommendation, while S‑LANSS (self-administered LANSS) and PainDETECT received weak recommendations for their use in the diagnostic workup of patients with possible neuropathic pain. There was astrong recommendation for the use of skin biopsy and aweak recommendation for quantitative sensory testing and nociceptive evoked potentials. The role of confocal corneal microscopy is still unclear. Functional imaging and peripheral nerve blocks are helpful in elucidating the pathophysiology, but current literature does not support their use in diagnosing neuropathic pain. In selected cases, genetic testing in specialized centers may be considered.

The Frequency of Neuropathic Pain and Associated Factors in Patients with Rheumatoid Arthritis

Abstract Objective The aim of this study was to evaluate the presence and incidence of neuropathic pain (NP) in patients with rheumatoid arthritis (RA) and to determine the relationship between neuropathic pain scores, quality of life and functional status. Methods 119 patients with RA and 45 control subjects with acute non-inflammatory pain were recruited for the study. Disease activity with DAS28 (Disease Activity Score-28), pain visual analog scale, functional status and quality of life were recorded. Quality of life was evaluated with the Rheumatoid Arthritis Quality of Life Scale (RAQoL), and functional status was assessed with the Health Assessment Questionnaire (HAQ). The presence of NP was evaluated with the LANSS (Leeds Assessment of Neuropathic Symptoms and Signs), Douleur Neuropathique 4 (DN4) and painDETECT questionnaires (PDQ). Results The prevalence of NP according to LANSS, DN4 and PDQ was 63.9%, 58.8% and 51.3% in the RA group and 6.7%, 4.4% and 4.4% in the control group, respectively. NP scores were significantly higher in the RA group (p<0.001). LANSS, DN4 and PDQ scores correlated with VAS, HAQ and RAQoL scores. Conclusion The NP evaluated with different pain questionnaires is not rare in patients with RA and is related to functional status and quality of life.

PASHTO TRANSLATION, VALIDITY AND RELIABILITY OF LEEDS ASSESSMENT OF NEUROPATHIC SYMPTOMS AND SIGNS (LANSS) IN SPINAL CORD INJURY PATIENTS

Objective: The aim pf this study was to translate to translate English version of Leeds assessment of Neuropathic symptoms and signs (LANSS) pain scale into Pashto language and to determine the validity and reliability of Pashto version of LANSS pain scale in spinal cord injury patients. Material & Methods: LANSS was translated from original language into Pashto and then back translated to English. It was reviewed by ten physical therapy experts for face and content validity. The scores of the Pashto version of the LANSS were studied in a sample of 113 spinal cord injury patients having pain from Pashto speaking region, Khyber Pakhtunkhwa, Pakistan. Comparison between Pashto LANSS and DN4 Questionnaire score was done to check for concurrent validity. Intra-class correlation coefficient, Cohen’s kappa agreement and internal consistency were estimated to check the reliability of Pashto version of LANSS. Results: For a p-value of <0.01, the overall mean score of Pashto-LANSS was higher in patients suffering from neuropathic pain. The ICC score for Pashto-LANSS was 0.76, kappa value 0.76 and Cronbach’s alpha 0.83 indicating significant scores. The results of Pearson’s correlation showed significant correlation between Pashto-LANSS and DN4. Conclusion: Pashto LANSS is a reliable and valid tool to identify neuropathic pain in SCI patients. Pashto version of LANSS can be used in differentiating neuropathic pain from nociceptive pain in people with spinal cord injury (SCI). Key terms: LANSS, Neuropathic pain, DN4 Questionnaire, Spinal cord injury, Pashto version of LANSS (Pashto-LANSS).

Incidence of Different Characters of Neuropathic Pain in Cancer Patients Coming to Tertiary Care Centre in North India Over A Period of 1 Year - An Observational Study.

Pain is classified as nociceptive, neuropathic, or nociplastic. Neuropathic pain presents as variable phenotypes (characters) based on specific aetiology and pathophysiology. This study aimed to find out among cancer patients the incidence of different phenotypes of neuropathic pain and form specific phenotypic clusters based on the underlying neurophysiology and association of sensory profile with various organ systems - A prospective observational study. The Institutional Ethical Committee clearance (IEC code: 2020-49-MD-EXP-15) https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=44886&EncHid=88651.15716&userName=CTRI/2020/09/027964 approval was obtained. After written and informed consent, patients of age group 18-80 years, registering in the pain and palliative outpatient department or radiotherapy department with complaints of pain and not taking any anti-neuropathic pain medications, were enrolled. They were assessed using Leeds assessment of neuropathic symptoms and signs (LANSS) pain score, and a score of >12 was eligible for assessment of neuropathic pain phenotypes. Out of 210 cancer patients complaining of pain, a neuropathic component with LANSS >12 was found in 73 (34.76%). The most predominant phenotypes, allodynia> tingling> pricking = burning, were found in 72.60%, 56.16%, and 43.84% of patients, respectively. Phenotypes were clustered into Nodes 1 and 2 based on clinically significant separation of phenotypes. Node 1 had neuropathic pain of spontaneous origin found predominantly in gastrointestinal tract (GIT) and genitourinary tract (GUT) cancers. Node 2 had stimulus-evoked negative and positive characters which occurred in head and neck, thoracic, and spinal metastatic cancers. Careful patient assessment reveals the incidence of neuropathic pain in 34.76%; allodynia and tingling astable the most prominent phenotypes. Broadly, sensory characters were clustered into spontaneous and stimulus-evoked sensations with GIT and GUT cancers presenting with Node 1 symptoms.

A Case of Postherpetic Neuralgia Treated with Korean Medicine, including Soeumin <italic>Bojungikgitang-gagambang</italic>

Objectives: This study reports on the effect of Korean medicine treatment, including Soeumin <i>Bojungikgitang-gagambang</i>, on a patient with postherpetic neuralgia.Methods: The patient received Korean herbal medicine, pharmacopuncture treatment, and acupuncture treatment for 22 days. We assessed changes in symptoms due to the treatment using the Numeric Rating Scale (NRS), the McGill Pain Questionnaire-Short Form (SF-MPQ), and the European Quality of Life-5 Dimensions (EQ-5D) scale. We also measured the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) to distinguish neuropathic pain.Results: After treatment, the patient showed decreased NRS, SF-MPQ, and EQ-5D scores.Conclusion: The results indicate that Korean medicine treatment, including Soeumin <i>Bojungikgitang-gagambang</i>, is an effective management of symptoms in patients with postherpetic neuralgia.

A cross-sectional study on restless legs syndrome (RLS) in polycythemia vera (PV): is iron deficiency the only culprit?

ABSTRACT Introduction In polycythemia vera (PV) patients undergoing phlebotomy, iron deficiency (ID) may develop. ID has been linked to restless legs syndrome (RLS), and in one study, 29.6% of PV patients had RLS. We aimed to evaluate the frequency of RLS in PV and to evaluate factors that might play a role in RLS development among PV and essential thrombocythemia (ET) patients. Methods We consecutively included PV cases as the patient group, and ET and ID patients and healthy subjects (HSs) were included as controls. Those with conditions that could lead to RLS were excluded. All subjects were questioned according to the diagnostic criteria of the International Restless Legs Syndrome Study Group. Results Twenty-seven PV, 23 ET, and 22 ID patients and 23 HSs were included. RLS was detected in 25.9%, 34.8%, and 45.5% of PV, ET, and ID patients, respectively. None of the HSs had RLS. In univariate analysis, interferon-α and anagrelide use, magnesium levels, and the Leeds assessment of neuropathic symptoms and signs (LANSS) scores had a significant impact on RLS in PV and ET patients (p = 0.014, p = 0.032, p = 0.036, and p = 0.003, respectively). Conclusion RLS was more common among PV and ET patients than HSs, which was irrespective to the iron status. RLS was more frequent in ET patients than that observed in PV cases, indicating that ID may not be the only causative factor for RLS development in PV. Further prospective studies are needed to determine the prevalence and risk factors of RLS developing in PV and ET.

Clinical evaluation of painful diabetes peripheral neuropathy in type 2 diabetes patients: Lessons from expatriates in the United Arab Emirates

BackgroundThe high prevalence of Type 2 Diabetes (T2D) in the United Arab Emirates makes it imperative to screen and manage diabetes peripheral neuropathy (DPN) as a priority. Considering the high number of expats from different ethnicity a more thorough approach is necessary. Unfortunately, there are very few studies addressing this issue. MethodsThe study uses the chi-square test to investigate the dependence of the progression of DNP on ethnic origin. The study uses Pearson Correlation to find the association between three prevalent scales used for the measurement of painful diabetes peripheral neuropathy. Student t-test was used further to investigate the significance of the association. ResultsWith a p-value (0.004) and p-value (0.015), the study concludes that DPN risk is dependent on the ethnic origin of the residents. The study further found that there is a significant association between three scales for measuring painful diabetes peripheral neuropathy (pDNP), Douleur Neuropathique en 4 questions (DN4), Neurological Symptoms Score (NSS), and Leeds Assessment of Neuropathic Symptoms and Signs (LANNS). The p-value for all pairwise comparisons for the strength of association between scales was found significant at the level of significance 0.05. ConclusionThe study concludes that the risk of DNP is high in Arab-origin residents in UAE and the reasons behind the finding need to be empirically tested to customize its management. The study further finds a significant association between the score of the three scales used for measuring pDNP.

Relationship Between Work Experience and Risk of Neuropathic Pain Among Loading--Unloading Workers

Lifting and transporting activities are the most common tasks in the logistics sector, especially for loading-unloading workers. The workers continuously lift heavy loads, which leads to pain in the waist, back, arms, and legs. Neuropathic pain is a type of pain caused by peripheral nerve lesions. The aim of this study was to find the relationship between the different levels of work experience and the risk of neuropathic pain among loading-unloading workers. We used descriptive analytics as the method of the study. 65 healthy men aged 20-55 years, without health issues or diabetes mellitus, and active loading-unloading workers were recruited as study respondents. They were divided into three groups based on their different levels of work experience. We utilized the Leeds assessment of neuropathic symptoms and signs (LANSS) questionnaire to check whether the participant was at risk for neuropathic pain. Our results showed that 43% of participants identified as having less, 28% as middle, and 29% as having more work experience. Furthermore, work experience is significantly correlated to the risk of neuropathic pain (P<0.000). We concluded that the more experienced loading workers are, the more likely they are to experience neuropathic pain.
 Keywords: work experience, peripheral-neuropathy, pain, loading workers

Pregabalin in the Treatment of Peripheral and Central Chronic Neuropathic Pain.

Pregabalin is a first-line therapy of pain with additional positive effects on the states of depression and anxiety that often occur in patients with chronic pain, thus improving their quality of life. The aim of this study was to demonstrate the efficacy of pregabalin in reducing neuropathic pain and improving quality of life in patients with peripheral and central chronic neuropathic pain in Bosnia and Herzegovina. Also, the aim was to monitor the safety of therapy with pregabalin. The study included patients with neuropathic pain lasting more than 3 months. Based on the underlying disease, patients were divided into 5 groups: DM-patients with diabetes mellitus, M-patients after stroke, D-patients with lower back pain, MS-patients with multiple sclerosis, and P group-patients with spinal cord injury. During the baseline visit, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was used to assess neuropathic pain. During two follow-up visits (1.5 and 3 months after baseline), the 36-Item Short-Form Health Survey (SF 36) was used to assess the effectiveness of therapy on quality of life. The safety of the treatment was evaluated by monitoring the incidence of adverse drug reactions. The study included 125 patients. During treatment with pregabalin, there was a statistically significant reduction in pain intensity in the DM, M, D and MS groups. In group P, the decrease in pain intensity was not statistically significant (p = 0.070). There was a significant improvement in different parameters of the quality of life in all analyzed groups, with the most prominent effects in the DM group. The effectiveness of treatment was rated as "good" and "very good" in more than 70% of subjects in each group. The expected side effects of treatment were recorded in 27.1% of patients in the DM group, in 20.0% in the M group and in 22.2% in the MS group. Unexpected side effects of treatment were observed in one patient (2.1%) in the DM group. Assessment of tolerability of the applied treatment showed "good" and "very good" response in 68.7% of patients in DM group, 73.3% in M group, 74.5% in D group, 88.9% in MS group and 85.8% in P group. Pregabalin is a safe and effective drug in treatment of neuropathic pain of different etiology.

Cross-cultural adaptation and validation of the Ukrainian version of the Standardized Evaluation of Pain (StEP) — a tool for assessing neuropathic pain in the lower back in patients with ankylosing spondylitis

Objective — to create a Ukrainian‑language version of the Standardized Evaluation of Pain (StEP) through translation and cross‑cultural adaptation with subsequent validation in patients with ankylosing spondylitis (AS).
 Methods and subjects. The translation and cross‑cultural adaptation of the StEP questionnaire was carried out in accordance with the standard recommendations of the Guidelines for the process of cross‑cultural adaptation of self‑report measures. 49 patients with a diagnosis of AS according to the modified New York criteria and duration of pain in the lower back ≥ 3 months and 31 persons of the control group were examined. AS activity in patients was assessed using the ASDAS (Ankylosing Spondylitis Disease Activity Score) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), functional status — according to the BASFI (Bath Ankylosing Spondylitis Functional Index) and BASMI (Bath Ankylosing Spondylitis Metrology Index) indices. The ASQoL (Ankylosing Spondylitis Quality of Life Questionnaire) index was used to assess the quality of life of AS patients. The intensity of pain in AS patients was determined using a visual analog scale. The Leeds assessment of neuropathic symptoms and signs (LANSS) and the DN4 questionnaire (Douleur Neuropathique en 4 Questions) were used to compare the results of the StEP questionnaire. The statistical analysis of the results was carried out using the methods of variational statistics using the SPSS22 software package (SPSS Inc.).
 Results. According to disease activity indices, high and very high disease activity prevailed in patients with AS: the average value according to ASDAS was 3.8 ± 0.8, according to BASDAI — 5.5 ± 1.2. Functional disorders according to BASFI were 5.2 ± 1.8 on average, range of motion in the spine according to BASMI was 5.2 ± 2.3. The quality of life of patients with AS according to ASQoL was on average 8.3 ± 4.4. Pain intensity according to the visual analog scale — 6.1 ± 1.5. The reliability of the Ukrainian‑language version of the StEP questionnaire was assessed by the test‑retest method with an interval of 7 days in 22 patients with AS. The analysis of the received data proved the high reliability of the StEP questionnaire (intraclass correlation coefficient was 0.987). Cronbach’s alpha coefficient (0.987) confirmed the internal consistency of the Ukrainian version of the StEP questionnaire. The sensitivity of the StEP questionnaire showed a close pairwise correlation (Spearman’s correlation coefficient — 0.955). Testing of the StEP questionnaire in patients with AS revealed the presence of neuropathic pain in 55.1 % of cases. The average value of the StEP questionnaire in AS patients was 4.6 ± 5.3, in the control group it was 0.1 ± 0.4. The final values of the StEP questionnaire were statistically significantly correlated with LANSS and DN4 indicators (p < 0.01).
 Conclusions. The Ukrainian‑language version of the StEP questionnaire was created, and its cross‑cultural adaptation and validation was carried out. The Ukrainian‑language version of the StEP questionnaire showed a sufficient level of reliability and validity for further use in scientific and medical practice for the Ukrainian‑speaking population. In patients with AS, using the Ukrainian version of the StEP questionnaire, the presence of a neuropathic component of the pain syndrome is detected in 55 % of cases, which should be taken into account when treating this cohort of patients.

The relationship between fatigue, neuropathic pain, and neurophysiological features in carpal tunnel syndrome

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy and can affect patients' daily living activities. In this study, it was aimed to find out whether there is a relationship between fatigue, neuropathic pain and neurophysiological features in CTS.
 Material and Method: Patients with clinical features compatible with CTS were included in this retrospective study. Median nerve compound muscle action potential (CMAP) and compound nerve action potential (CNAP) of the patients were analyzed. The Turkish version of the Fatigue Severity Scale (FSS) was administered to all patients. Patients with a mean FSS score of ≥4 were considered to have fatigue. In addition, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was applied to some patients. If the LANSS score was 12 or higher, these patients were considered to have neuropathic pain.
 Results: Thirty-two female and eight male CTS patients were included in the study. Thirty-two patients had clinically bilateral CTS and eight patients had right-sided CTS. FSS and LANSS were administered to 40 and 18 patients, respectively. There were 29 CTS patients (72.5%) with an FSS score ≥ 4. CNAP/CMAP amplitudes and sensory/motor nerve conduction velocities of patients with fatigue were lower than those without fatigue (p

The assessment of neuropathic pain in patients with prediabetes

AimsNeuropathic pain is associated with several clinical conditions, including anxiety, depression, sleep disorders, and decreased quality of life; however, less evaluated in prediabetes. This study aims to assess neuropathic pain through validated diagnostic tools in prediabetes. MethodsOne hundred and seventy-two patients with prediabetes and 170 controls were included in this cross-sectional study. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale and Douleur Neuropathique 4 Questions (DN4) were used to evaluate neuropathic pain. The Visual Analog Scale (VAS) was used to estimate pain intensity. ResultsTwenty-three (13.4%) and 12 (7%) patients with prediabetes were diagnosed with neuropathic pain using DN4 and LANSS questionnaires, respectively. Neuropathic pain rates of the patients were higher than controls with two pain scales (p < 0.001). VAS scores were higher in prediabetes group than in controls (p = 0.021). LANSS, DN4, and VAS scores were positively correlated with HbA1c level (r = 0.184, p = 0.016; r = 0.180, p = 0.018; r = 0.188, p = 0.014, respectively). LANNS and DN4 scores were higher in female patients than in males (p < 0.001). ConclusionsNeuropathic pain was increased in prediabetes by DN4 and LANNS questionnaires. An appropriate diagnosis of neuropathic pain in prediabetes may prevent patients from different pain-related clinical conditions.

Effects of Thoracic Paravertebral Block on Postoperative Anxiety and Depression for Patients Undergoing Thoracoscopic Lung Cancer Radical Surgery.

This study is aimed at investigating the effect of thoracic paravertebral block (TPVB) on the occurrence of chronic postoperative pain, postoperative anxiety, and depression in patients undergoing thoracoscopic radical lung cancer surgery. A total of 120 patients who underwent thoracoscopic radical lung cancer surgery in our hospital from June 2019 to March 2021 were included. There were 62 males and 58 females, with an age of 18-75 years old and a body mass index of 20-28 kg/m2. Patients were divided into two groups using the random number table method, TPVB group (n = 60) and normal saline group (control group, n = 60). Two-point nerve block was performed at T5-6 and T6-7 levels. Patients in the TPVB group received nerve block with 15 mL of 0.375% ropivacaine hydrochloride, while those in the control group received 5 mL of 0.9% normal saline. The numeric rating scale (NRS) scores at rest and during movement at 24 and 48 hours after surgery and the number of times the button on the patient-controlled analgesia pressed at 24 h after surgery in two groups were recorded. All patients were followed up by outpatient visits or phone visits at 1 year after surgery and assessed using Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and Hospital Anxiety and Depression Scale (HADS). According to the inclusion, exclusion, and drop-out criteria, 108 patients were finally included, with 52 patients in the TPVB group and 56 patients in the control group. There was no statistically significant difference between the two groups in terms of age, sex, height, body weight, body mass index, ASA classification, and operation time (P > 0.05). NRS pain scores at 24 h (P = 0.0108) and 48 h (P = 0.0000) after surgery, the number of times pressing patient-controlled analgesia at 24 h after surgery (P = 0.0000), the LANSS scores (P = 0.0000), HADS anxiety score (P = 0.0000), and depression scores (P = 0.0000) at 1 year after surgery in the TPVB group were both significantly lower than those in the control group. To sum up, ultrasound-guided TPVB can effectively relieve pain at 48 hours after thoracoscopic lung cancer radical surgery and chronic postoperative pain at 6 months after V thoracoscopic lung cancer radical surgery.

Comparison of cutaneous silent period parameters in patients with primary Sjögren's syndrome with the healthy population and determination of ıts relationship with clinical parameters.

Small fiber neuropathy (SFN) is one of the main neurological manifestations in primary Sjögren's Syndrome (pSS). For the detection of SFN, cutaneous silent period (CSP) measurement is gaining popularity recently due to its non-invasiveness and practical application. Evaluating SFN involvement in patients with pSS using CSP and evaluating its relationship with clinical parameters. Patients with a diagnosis of pSS and healthy volunteers demographically homogeneous with the patient group were included in the study. The CSP responses were recorded over the abductor pollicis brevis muscle. The latency and duration values of the responses were obtained. In patient group, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36) questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Central Sensitization Inventory (CSI) were applied for the evaluation of symptom severity, mood, quality of life, presence of neuropathic pain and central sensitization, respectively. The mean CSP latency was significantly longer in patient group compared to control group (p < 0.001). Mean CSP duration was also significantly shorter in patient group (p < 0.001). There were no significant differences in CSP parameters according to patients' neuropathic pain or central sensitization profile. There were significant correlations of CSP parameters (latency and duration, respectively) with ESSPRI dryness (ρ = 0.469, p = 0.004; ρ = -0.553, p < 0.001), fatigue (ρ = 0.42, p = 0.011; ρ = -0.505, p = 0.002), pain (ρ = 0.428, p = 0.009; ρ = -0.57, p < 0.001) subscores and mean ESSPRI score (ρ = 0.631, p < 0.001; ρ = -0.749, p < 0.001). When SF-36 subscores and CSP parameters were investigated, a significant correlation was found only between "bodily pain" subscore and CSP duration (ρ = -0.395, p = 0.017). In HADS, LANSS and CSI evaluations, a significant correlation was found only between HADS anxiety score and the CSP duration (ρ = 0.364, p = 0.02). As indicated by CSP measurement, SFN is more prominent in patients with pSS than in the healthy population. It is important to investigate the presence of SFN because of its correlation with the leading symptoms in the clinical spectrum of pSS.

Cross-Sectional Comparative Study on Central Sensitization-Psychosocial Associated Comorbidities and Psychological Characteristics in Breast Cancer Survivors with Nociceptive Pain and Pain with Neuropathic Features and without Pain.

Simple SummaryPersistent pain after breast cancer treatment is still under research due to its complex and multifactorial underlying pathogenesis, including phycological factors. Further research is needed to elucidate more information about the factors that cause and perpetuate this pain. Thus, this study defined the influence of psychosocial and psychological factors on breast cancer survivors who report pain and those who do not. The psychosocial factors assessed were those that are associated with a central sensitization process, and the psychological factors were pain catastrophizing, fear of movement, anxiety and depression. Hence, the psychosocial symptom clusters were identified related to the clinical features of pain or to not reporting pain, which may encourage health clinicians to establish a customized biopsychosocial model focused on the management of pain-catastrophizing thoughts and fear of movement. Furthermore, anxiety and depression should be detected early by health professionals and referred to psychologists to be managed.The frequency of a high Central Sensitization Inventory (CSI) total score and the prevalence of pain have already been established among breast cancer survivors (BCS). However, the psychological factors’ influence based on the clinical features of pain is still unknown, as well as BCS characteristics with no pain. Thus, our main aim was to evaluate the presence of a high CSI total score in BCS with pain and compare it with BCS without pain and to evaluate the influence of psychosocial factors. A cross-sectional comparative study was designed to compare BCS with nociceptive pain (n = 19), pain with neuropathic features (n = 19) or no pain (n = 19), classified by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). CSI, pain catastrophizing, fear of movement, anxiety and depression symptoms were analyzed and compared among the three groups. The CSI total score was higher in both BCS pain groups compared to BCS without pain, but there were no statistical differences between the pain groups. The same observation was made when comparing pain catastrophizing. The neuropathic feature group showed greater levels of fear of movement, anxiety and depression compared to the no pain group. Thus, CS-psychosocial associated comorbidities and pain-catastrophizing thoughts were more prevalent among BCS with pain, regardless of the clinical features of pain. BCS with neuropathic pain features showed greater psychological disturbances.

Comparison of Clinical Symptoms and Neurophysiological Findings in Patients With Chemotherapy Induced Peripheral Neuropathy.

IntroductionTaxanes are associated with a distal sensory neuropathy, significantly affecting cancer survivor quality of life. However, chemotherapy-induced peripheral neuropathy (CIPN) assessments are primarily based on clinical symptoms rather than objective neurophysiologic findings. Therefore, we investigated neurophysiologic changes in symptomatic subjects, comparing them with symptom severity.Materials and MethodsMedical charts of 111 subjects who were referred for CIPN diagnosis after chemotherapy for breast or ovarian cancer between May 1, 2016, and December 31, 2019, were retrospectively reviewed. Demographics, anthropometric parameters, and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale data were collected. The nerve conduction study (NCS) results, including sensory nerve action potentials recorded from sural nerves, were analyzed relative to clinical symptoms. To optimize follow-up (FU) NCS diagnostic sensitivity, relative references of FU sural amplitude reductions to >30% and an absolute reference <10 μV were used.ResultsEighty-eight female patients met the criteria, and 20 underwent FU NCS. Baseline and FU sural amplitudes showed significant positive correlation with respective LANSS scores (p < 0.01). FU sural amplitude was significantly lower than the initial result (p < 0.05). The FU LANSS score was not different from the initial score. Initial NCS sensitivity and specificity for clinically suspected CIPN diagnoses with LANSS were 69.7 and 47.3%, respectively. All 20 subjects with FU evaluation were clinically compatible with CIPN (LANSS >12) at initial and FU assessments. Among them, only six (30.0%) had abnormal sural amplitudes (<10μV for ≤50 s, <3 μV for 60 s, <1 μV for 70 s) in the initial NCS. In the FU NCS, sural amplitude became abnormal in five additional subjects. Between the initial and FU NCS, sural amplitude was reduced by > 30% in eight subjects (40.0%). NCS sensitivity increased to 65.0% when including either abnormal sural amplitudes or a > 30% reduction in sural amplitude in FU studies.ConclusionsAlthough clinical symptoms and NCS results were positively correlated, a single NCS point had limited value for suspected CIPN electrophysiological diagnoses. Serial NCS during chemotherapy might help assess the degree of chemotherapy-induced nerve damage, attain evidence of CIPN prior to symptom aggravation, and monitor the progression of CIPN. Further study is needed to find specific relative references for variable patient factors to increase the sensitivity of electrophysiological studies of clinically suspected CIPN.

HIV-associated painful neuropathy: where are we?

After the advent of combination antiretroviral therapy, infection with the human immunodeficiency virus (HIV) ceased to be a devastating disease, but sensory neuropathy resulting from the permanence of the virus and the side effects of treatment have worsened the morbidities of these patients. To investigate the quality of life of 64 HIV-positive patients: 24 with painful neuropathy (case group) and 40 without painful neuropathy (control group). The impact of other factors on quality of life was also assessed. To assess painful neuropathy, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, Douleur Neuropathique 4 (DN4) questions and Neuropathy Disability Score (NDS) were used. The Short Form Health Survey (SF-36) scale was used to assess quality of life. Factors related or unrelated to HIV were obtained through the medical history and analysis on medical records. The quality of life of patients with neuropathic pain was worse in six of the eight domains of the SF-36 scale. The number of clinical manifestations related to HIV, length of time with detectable viral load since diagnosis, length of time since the diagnosis of HIV infection and length of time of HAART use had a negative impact on quality of life. Higher levels of CD4, education and family income had a positive impact. Painful neuropathy related to HIV is a factor that worsens the quality of life of patients infected with this virus and should be included in the clinical evaluation.

Physical therapy versus radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome: A randomized-controlled study.

Objectives This study aims to compare the efficacy of physical therapy (PT) and radial extracorporeal shock wave therapy (rESWT) in the treatment of carpal tunnel syndrome (CTS). Patients and methods Between May 2020 and July 2020, a total of 125 wrists of 95 patients (22 males, 73 females; mean age: 54.3±11.3 years; range, 19 to 69 years) with mild-to-moderate CTS were allocated into three groups and evaluated. The control group (Group 1, n=42) was treated with splinting and an exercise program. Group 2 (n=42) was treated with a total of three sessions of rESWT, splinting and an exercise program. Group 3 (n=41) was treated with a total of 15 sessions of PT modalities, splinting, and an exercise program. Each patient was evaluated before, three weeks and 12 weeks after treatment using a Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale, and electrodiagnostic testing. Results The reduction in VAS, BCTQ, LANSS, and improvement in sensory nerve conduction velocity were significantly greater at three and 12 weeks of follow-up in Groups 2 and 3, compared to Group 1 (p<0.001). A greater improvement was observed in all clinical parameters in Group 2, compared to Group 3 (p<0.001). Conclusion This is the first study to compare the treatment outcomes of PT and rESWT in the treatment of CTS. The results of this study show that both PT and rESWT are effective in the treatment of CTS; however, rESWT yields superior treatment effects compared to conventional PT. The practicalities of administering rESWT and its efficacy in the treatment of CTS may make it the treatment of choice.

Abstract No. : ABS2584: Incidence of different phenotypes of neuropathic pain in cancer patients coming to tertiary care centre in North India over a period of one year -An observational study .

Background and Aims:Neuropathic pain can present as characters(phenotypes) based on specific etiology, which can be grouped together to form phenotypic clusters. This study aimed to find out the incidence of different phenotypes amongst cancer patients and form phenotypic clusters.Methods:Institutional Ethics Committee clearance and clinical trial registration registration were obtained. After written and informed consent, patients aged between 18-80years, registering in Pain and palliative out-patient department or Radiotherapy department with complaint of pain and noton any anti-neuropathic pain medications, were enroled. They were assessed using the Leeds assessment of neuropathic symptoms and signs(LANSS) pain score and a score of >12 was eligible for assessment of neuropathic pain phenotypes.Results:Out of 261 patients ,73 had LANSS>12 (28%). The incidence of various characters of neuropathic pain has been shown in figure 1. The phenotypes were clustered in 3 groups based on spontaneous pain(cluster I), stimulus evoked positive pain(cluster II) and stimulus evoked negative pain(cluster III) and they were correlated with different organ systems. Most of the patients had combined phenotypic sensory profile of cluster I+II.Figure 1- Incidence of different phenotypes of neuropathic painConclusion:Careful patient assessment can reveal different phenotypic combinations of pain and hence guide targeted therapy. Individuals’ sensory profiles should be used to select the patients who are most likely to benefit from treatment with drugs used for neuropathic pain.

The association of Type D personality with functional outcomes, quality of life and neuropathic pain in persons with spinal cord injury.

Cross-sectional study. This study aimed to investigate the association of Type D personality (TDP) with functional outcomes, health-related quality of life (HRQoL) and neuropathic pain in persons with spinal cord injury (SCI), using dichotomous and continuous analysis methods. Tertiary rehabilitation center. This study included 105 persons with SCI. Independence level was determined using the Functional Independence Measure (FIM)-motor subscale. The Short Form-36 questionnaire (SF-36) was used to assess HRQoL. TDP (combined existence of negative affectivity and social inhibition) was assessed using Type D Scale-14 (DS-14). Presence of chronic pain was questioned and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale was used to distinguish neuropathic pain from others. In dichotomous method, the FIM-motor score was significantly lower in persons with TDP (41 persons, 39%) (p = 0.025). Persons with TDP had significantly lower scores in vitality, emotional role and mental health. There was no significant difference between the groups, regarding neuropathic pain and LANSS scores (p > 0.05 for all). Negative affectivity and total DS-14 scores had negative correlation with mental health and vitality. In continuous interaction method, TDP predicted mainly the mental health components of SF-36 (particularly, vitality and mental health). Negative affectivity was the driving factor. TDP was not associated with FIM-motor, VAS pain or LANSS scores. Mental component of HRQoL is associated with Type D in persons with SCI in both analyses. Assessment of potential differences related with TDP may be beneficial to develop and apply person-specific goals in SCI rehabilitation.