Table 2 - uploaded by Michael I Bennett
Content may be subject to copyright.
Source publication
Management of patients presenting with chronic pain is a common problem in primary care. Essentially, the classification of chronic pain falls into 3 broad categories: (1) pain owing to tissue disease or damage (nociceptive pain), (2) pain caused by somatosensory system disease or damage (neuropathic pain), and (3) pain without a known somatic back...
Context in source publication
Context 1
... often, patients report mechanical hypersensitivity, followed by hypersen- sitivity to cold. A summary of terms commonly used to describe these symptoms is presented in Table 2. 41,42 Neuropathic pain often has a burning, lancinating, or shooting quality with unusual tingling, crawling, or electri- cal sensations. ...
Citations
... [24] Clinical syndromes of neuropathic pain due to neuropathy, neuralgia, and central pain are well-recognized at the primary care level as the diagnosis is based on objective neurological signs and positive correlation with investigations. [25,26] Complex regional pain syndrome type 1 is the only neuropathic pain condition that needs special attention to recognize and treat. [27] Nociceptive pain syndrome, however, is due to various inflammatory and post-traumatic conditions, and its diagnosis can be confirmed with the help of local examination and inflammatory markers. ...
... Chronic pain conditions are more prevalent in the female population as shown in our previous studies. [24][25][26][27][28][29] There is no obvious explanation for the gender difference in chronic pain, and genetic, anatomic, biological, hormonal, and psychosocial factors were evaluated for high prevalence of chronic persistent pain in women. [30] Low level of ferritin is one specific factor related to pain in females as only women are at higher risk for having low ferritin levels specially if they have history of menorrhagia or polymenorrhagia. ...
A BSTRACT
Background
Understanding and dealing with chronic nonspecific pain (CNP) is the important entity at primary care hospital. Chronic nonspecific multiple-site pain [CNMSP] of unknown etiology creates diagnostic and therapeutic challenges for primary care physicians due to lack of guidance regarding evaluation and treatment.
Aims and Objectives
To classify and formulate the evaluation, treatment strategies, and prediction of prognosis of patients with CNMSP of unknown etiology.
Methods
Patients present with CNMSP of more than 3-month duration without any obvious medical cause. The biopsychosocial [BPS] model with 3P model was applied to see the biological, psychological, and social factors behind persistence. Finally, patients were classified into four groups for evaluation response to treatment and relapse rates in 12-month follow-up.
Results
Of the total 243 patients of CNMSP, 243 [96.3%] were females. Sixty [24.7%] patients had short duration, and 183 [75.3%] had long duration. Headache was in 115 [47%], low back pain ± leg pain in 96 [39.4%], cervical pain ± shoulder/arm pain in 83 [34.1%], and diffuse body pain in 50 [20.5%] in various combinations. A total of 155 [63.8%] patients had high somatization–sensitization index (SSI), and 144 [59.3%] had low ferritin level. Group 1 [high SSI and low ferritin] had 37.9% of patients, group 2 [high SSI and normal ferritin] had 25.9% of patients, group 3 [low to medium SSI with low ferritin] had 21.4% of patients, and group 4 [low to medium SSI with normal ferritin] had 14.8% of patients. Response to pain symptoms was better in group 1, and relapse rate was higher in group 2.
Conclusion
CNMSP of unknown etiology itself is a heterogeneous entity, and assessment based on the BPS model can be very useful to understand the treatment plan and outcome of these patients.
... This study describes 4 different levels of sensory profile assessment in patients with cancer pain: the S-LANSS questionnaire, the simplified neurological assessment made by the treating physician to apply the EAPC/IASP algorithm, the more comprehensive bedside neurological examination, and the QST, emphasizing the role of physical examination to provide an accurate diagnosis. 10,[15][16][17] The QST profiling of cancer pain showed an important impairment of thermal detection thresholds; yet in some cases, this will be difficult to notice in clinical practice. We believe that the use of a simple objective examination as in the EAPC/IASP algorithm will lead to the detection of most patients with sensory disturbances, as demonstrated also here, and it is easy to perform and not time-consuming. ...
Introduction
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.
Objectives
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).
Methods
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.
Results
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).
Conclusion
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.
... Los tratamientos conservadores siguen siendo la primera opción terapéutica. Entre ellas, el Grupo de Interés Especial en el Dolor Neuropático de la Asociación Internacional para el Estudio del Dolor recomienda la farmacología como tratamiento de primera línea (Haanpää et al., 2009). Sin embargo, la eficacia es limitada, con efectos secundarios a menudo inaceptables (Finnerup et al., 2010(Finnerup et al., , 2018. ...
La prevalencia exacta del dolor neuropático periférico es desconocida. La complejidad y las múltiples presentaciones clínicas dificultan su abordaje. Por ello, se antoja necesario conocer los mecanismos patobiológicos que acontecen en los pacientes con este tipo de afección. La fisioterapia ha emergido en los últimos años como una alternativa o complemento a los tratamientos médicos convencionales. En este trabajo, se introducen aspectos fundamentales del dolor neuropático y las neuropatías por atrapamiento, y se revisa el conocimiento relacionado con los mecanismos de acción de las distintas técnicas de fisioterapia sobre el dolor neuropático y el proceso fisiopatológico de las neuropatías por atrapamiento.
... Aδ-fibers are myelin-ensheathed fibers that project to the lamina III and IV. These fibers respond to a weaker intensity of stimuli and are responsible for the sensation of a quick shallow that is specific on one area and termed as first pain [54,59,60]. Interestingly, we found that the V1aR co-localized with CGRP in C-fibers (second pain) (Fig. 17b) and V1bR co-localized with CASPR in Ranvier nodes in the Aδ-fibers (first pain) (Fig. 16a). ...
Background
Hypothalamus is a key region in migraine attacks. In addition, women are disproportionately affected by migraine. The calcitonin gene-related peptide (CGRP) system is an important key player in migraine pathophysiology. CGRP signaling could be a target of hormones that influence migraine. Our aim is to identify the expression of vasopressin and its receptors in the brain and in the trigeminovascular system with focus on the migraine-related regions and, furthermore, to examine the role of sex on the expression of neurohormones in the trigeminal ganglion.
Methods
Rat brain and trigeminal ganglia were carefully harvested, and protein and mRNA levels were analyzed by immunohistochemistry and real-time PCR, respectively.
Results
Vasopressin and its receptors immunoreactivity were found in migraine-related areas within the brain and, in the trigeminal ganglion, predominantly in neuronal cytoplasm. There were no differences in the number of positive immunoreactivity cells expression of CGRP and vasopressin in the trigeminal ganglion between male and female rats. In contrast, the number of RAMP1 (CGRP receptor), oxytocin (molecular relative to vasopressin), oxytocin receptor and vasopressin receptors (V1aR and V1bR) immunoreactive cells were higher in female compared to male rats. Vasopressin and its receptors mRNA were expressed in both hypothalamus and trigeminal ganglion; however, the vasopressin mRNA level was significantly higher in the hypothalamus.
Conclusions
A better understanding of potential hormonal influences on migraine mechanisms is needed to improve treatment of female migraineurs. It is intriguing that vasopressin is an output of hypothalamic neurons that influences areas associated with migraine. Therefore, vasopressin and the closely related oxytocin might be important hypothalamic components that contribute to migraine pathophysiology.
... Therefore, primary care physicians play a critical role in helping patients with chronic pain achieve the highest possible quality of life by alleviating their pain and improving their functioning under the most challenging conditions, interdisciplinary approaches, and pain management. 10 GPs play a crucial role in managing NP. However, previous quantitative research has shown that they are not convinced of this. ...
An important public health issue is neuropathic pain. It is a common, persistent, and severely disabling condition experienced by those in primary care. An important first step is an accurate diagnosis. It is the first step toward effective pain and disability reduction and management. The history may indicate the presence of pain, and a physical examination may confirm it. Medical professionals lack the skills necessary to diagnose and treat neuropathy pain, in part due to inadequate training during medical school and residency. The primary care physician is critical in avoiding delay in diagnosis, providing proper evaluation and treatment, and improving outcomes while reducing the financial burden on society economy. Citation: Anwar S. Neuropathic pain: The missing link at the general physician level. Anaesth. pain intensive care 2022;26(5):585-587; DOI: 10.35975/apic.v26i5.2021
... 31 With the distinction between nociceptive and neuropathic pain in IASP terminology, 20 positive identification criteria became available for each of them as well as for their combination (both 5 "mixed pain"); chronic pain conditions without damage to neural or nonneural tissue were left without a clear designation (neither 5 "idiopathic"). 10 This situation motivated a group of pain experts to develop a third mechanistic descriptor "nociplastic pain." 16 The grading system for its diagnosis 15 starts by establishing that the pain is neither nociceptive nor neuropathic (equivalent to the designation as idiopathic) and then calls for clinical evidence for central sensitization. ...
Mary-Ann Fitzcharles et al. propose to introduce “regional fibromyalgia” as a new diagnosis. This commentary summarizes why this term is misleading but nonetheless the article may pave the way towards useful concepts for myofascial pains.
... Pain in the leg does not always imply a lesion or disease of the nerve roots or the peripheral nervous system [23][24][25]. Predominant nociceptive or neuropathic pain management differs from patient to patient [26]. The next part will thus detail how to distinguish between these pain mechanisms. ...
... Neuropathic pain is generally referred in a dermatomal or cutaneous distribution [32]. The most common descriptors used by patients are burning, lancinating, and is accompanied by unusual tingling, crawling, or an electrical shock or shooting in the leg [9,26,27]. The description of a patient with neuropathic pain is often characterized by specific neurological symptoms, such as positive (hyperalgesia and/or allodynia) and negative (loss of function) sensory signs [16,33]. ...
Low back pain (LBP) that radiates to the leg is not always related to a lesion or a disease of the nervous system (neuropathic pain): it might be nociceptive (referred) pain. Unfortunately, patients with low-back related leg pain are often given a variety of diagnoses (e.g. 'sciatica'; 'radicular pain'; pseudoradicular pain"). This terminology causes confusion and challenges clinical reasoning. It is essential for clinicians to understand and recognize predominant pain mechanisms. This paper describes pain mechanisms related to low back-related leg pain and helps differentiate these mechanisms in practice using clinical based scenarios. We illustrate this by using two clinical scenarios including patients with the same symptoms in terms of pain localization (i.e. low-back related leg pain) but with different underlying pain mechanisms (i.e. nociceptive versus neuropathic pain).
... 2 NeP may coexist with other types of pain such as nociceptive or psychogenic pain and various underlying mechanisms can be responsible for its development. 7 Since 2006, the painDETECT questionnaire (PDQ), one of the available screening tools available for NeP, has been utilized to quickly identify potential patients with NeP. 8 PDQ has been translated into many European languages 9,10 and Asian languages. [11][12][13] Since PDQ was mainly used to identify neuropathic components of pain in patients with chronic lower back pain, 14 there have been no reports evaluating the association between the preoperative presence of NeP in patients with cervical spine disorders and pre-/postoperative HRQOL. ...
Study design
A prospective observational study.
Objective
To evaluate the impact on surgical outcomes of preoperative neuropathic pain (NeP) assessed by the painDETECT questionnaire (PDQ) administered to participants undergoing cervical decompression surgery for degenerative cervical myelopathy (DCM).
Methods
Participating patients were separated into the Non-NeP group (preoperative PDQ score ≤ 12), and NeP group (score ≥ 13). They were asked to complete a booklet questionnaire, including NRS for pain, the Short Form-12 for PCS and MCS, EQ-5D, NDI, and COMI-Neck, at baseline and 1 year after surgery. The JOA score for DCM and radiological changes were also evaluated. Propensity scores were used for the generalized linear model to adjust the patients’ backgrounds.
Results
Of the 116 patients recruited, 105 completed the one-year follow-up. In this study, 31 (29.5%) and 74 (70.5%) patients in the NeP and non-NeP groups, respectively, were compared. Except for the higher female ratio in the NeP group (64.6% vs 33.2%, P = .009), preoperative demographic data and surgical factors were not significantly different between both groups. The NeP group showed greater neck/arm/hand NRS scores and worse pre- and postoperative NDI/EQ-5D/COMI-Neck scores at baseline and 1 year after surgery, but this was not significant in the MCS/PCS and JOA scores. Change scores of neck/arm/hand NRS scores and MCS/PCS/NDI/EQ-5D/COMI-Neck scores were not significant between both groups.
Conclusions
The preoperative NeP, assessed by PDQ, was observed in approximately 30% of patients with DCM who underwent decompression surgery. The presence of NeP was associated with worse pre- and postoperative NDI/EQ-5D/COMI-Neck scores.
... Positive (gain-of-function) symptoms include paresthesia (skin-crawling sensation or tingling), electric-shock-like sensations, spontaneous (not induced by a stimulus) ongoing pain, as well as shooting pain [29], whereas the negative (loss-of-function) symptoms include hypoalgesia (decreased sensitivity to nociceptive stimulus), hypoesthesia (reduced sensitivity to vibrations, numbness), weakness, and reflex changes [30]. In addition, most of the patients have hypersensitivity, burning, smarting, lancinating, and shock-like pains [31,32]. ...
... Positive (gain-of-function) symptoms include paresthesia (skin-crawling sensation or tingling), electric-shock-like sensations, spontaneous (not induced by a stimulus) ongoing pain, as well as shooting pain [29], whereas the negative (loss-offunction) symptoms include hypoalgesia (decreased sensitivity to nociceptive stimulus), hypoesthesia (reduced sensitivity to vibrations, numbness), weakness, and reflex changes [30]. In addition, most of the patients have hypersensitivity, burning, smarting, lancinating, and shock-like pains [31,32]. ...
... Several questionnaires have been designed to identify neuropathic pain. These include PainDETECT, ID-Pain, Neuropathic Pain Questionnaires, Neuropathic Pain Symptom Inventory, Leeds Assessment of Neuropathic Symptoms and Signs, and Douleur Neuropathique 4 questions [2,32]. The questions are designed to find out about pain attacks, tactile and thermal hypersensitivity, tingling, prickling, and insensibility. ...
Neuropathic pain affects more than one million people across the globe. The quality of life of people suffering from neuropathic pain has been considerably declining due to the unavailability of appropriate therapeutics. Currently, available treatment options can only treat patients symptomatically, but they are associated with severe adverse side effects and the development of tolerance over prolonged use. In the past decade, researchers were able to gain a better understanding of the mechanisms involved in neuropathic pain; thus, continuous efforts are evident, aiming to develop novel interventions with better efficacy instead of symptomatic treatment. The current review discusses the latest interventional strategies used in the treatment and management of neuropathic pain. This review also provides insights into the present scenario of pain research, particularly various interventional techniques such as spinal cord stimulation, steroid injection, neural blockade, transcranial/epidural stimulation, deep brain stimulation, percutaneous electrical nerve stimulation, neuroablative procedures, opto/chemogenetics, gene therapy, etc. In a nutshell, most of the above techniques are at preclinical stage and facing difficulty in translation to clinical studies due to the non-availability of appropriate methodologies. Therefore, continuing research on these interventional strategies may help in the development of promising novel therapies that can improve the quality of life of patients suffering from neuropathic pain.
... Molecules 2022, 27, 255 2 of 25 number of potential predisposing factors before and after the formation of a lesion can contribute to the manifestation of chronic pain, including age, gender difference, pain sensitivity, emotional disorders and cognitive impairment [5]. According to sensory classification, neuropathic pain can be divided into three types: ongoing pain, paraesthesias, and altered stimulus-response function, including allodynia (pain in response to a nonnociceptive stimulus), hyperalgesia (an increased pain sensitivity to a nociceptive stimulus), and loss of sensation in some areas. ...
Neuropathic pain is a refractory disease that occurs across the world and pharmacotherapy has limited efficacy and/or safety. This disease imposes a significant burden on both the somatic and mental health of patients; indeed, some patients have referred to neuropathic pain as being ‘worse than death’. The pharmacological agents that are used to treat neuropathic pain at present can produce mild effects in certain patients, and induce many adverse reactions, such as sedation, dizziness, vomiting, and peripheral oedema. Therefore, there is an urgent need to discover novel drugs that are safer and more effective. Natural compounds from medical plants have become potential sources of analgesics, and evidence has shown that glycosides alleviated neuropathic pain via regulating oxidative stress, transcriptional regulation, ion channels, membrane receptors and so on. In this review, we summarize the epidemiology of neuropathic pain and the existing therapeutic drugs used for disease prevention and treatment. We also demonstrate how glycosides exhibit an antinociceptive effect on neuropathic pain in laboratory research and describe the antinociceptive mechanisms involved to facilitate the discovery of new drugs to improve the quality of life of patients experiencing neuropathic pain.
