Activity 1: Principles of Neuropathic Pain Assessment and Management
Neuropathic pain presents the family physician with numerous challenges in terms of diagnosis and management. The condition is hard to differentiate from other chronic pain conditions, yet many physicians may be unaware of the existence of screening tools that can assist them in identifying neuropathic pain.1,2 In a survey of AAFP LearningLink participants, 55 percent of respondents said they did not use neuropathic pain screening tools on a regular basis. In fact, 37 percent of respondents were not aware that these tools existed.3
Neuropathic pain is more difficult to treat than other types of chronic pain.4 Patients exhibit a more variable response to analgesics,5 and the different pain mechanisms involved in the condition mean that combination therapy is frequently required.6 Comorbid conditions such as sleep deprivation, anxiety and depression also affect response to treatment. Ultimately, many patients require multidisciplinary strategies to achieve adequate pain relief and return to normal functioning.4,7,8
In this first activity, Principles of Neuropathic Pain Assessment and Management, the faculty describes a practical approach to the diagnosis and assessment of neuropathic pain, including the role of neuropathic pain screening tools. They discuss pharmacologic and nonpharmacologic management approaches, as well as outlining evidence-based treatment algorithms for the most common neuropathic pain syndromes. Finally, faculty members provide strategies for identifying and addressing common comorbidities.
- Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract 2000;47:123-8.
- Smith EL, Beck SL, Cohen J. The total neuropathy score (TNS): a tool for measuring chemotherapy-induced peripheral neuropathy. Oncol Nurs Forum 2008;35:96-102.
- Data on file. AAFP Neuropathic Pain Baseline Assessment. January 2011.
- Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132(3):237-51.
- Portenoy RK, Foley KM, Inturrisi CE. The nature of opioid responsiveness and its implications for neuropathic pain: new hypotheses derived from studies of opioid infusions. Pain 1990;43(3):273-86.
- Gilron I, Max MB. Combination pharmacotherapy for neuropathic pain: Current evidence and future directions. Expert Rev Neurother 2005;5:823-30.
- Hall CG, Carroll D, Parry D, McQuay HJ. Epidemiology and treatment of neuropathic pain: the UK primary care perspective. Pain 2006;122:156-62.
- Chen H, Lamer TJ, Rho RH, Marshall KA, Sitzman BT, Ghazi SM, et al. Contemporary management of neuropathic pain for the primary care physician. Mayo Clin Proc 2004;79(12):1533-45.
This continuing medical education program is intended for family physicians and other primary care providers who care for patients with neuropathic pain.
After completing this activity, family physicians will be better able to:
- Apply evidence-based recommendations for assessment and management of neuropathic pain in clinical practice.
- Recognize signs and symptoms of neuropathic pain to facilitate timely diagnosis and management.
- Differentiate among commonly encountered neuropathic pain conditions and their various causes in order to select appropriate treatments.
- Improve assessment of neuropathic pain in clinical practice, including assessment of comorbidities.
- Apply evidence-based strategies in the selection and use of first-, second- and third-line pharmacotherapy for patients with common neuropathic pain syndromes.
- Develop tailored treatment plans that address common and potentially debilitating comorbidities, such as depression and sleep disturbances.
- Implement practical approaches to monitoring treatment response, managing adverse effects and optimizing outcomes.
Dawn Marcus, MD
Professor of Anesthesiology and Neurology
University of Pittsburgh Medical Center
Penny Tenzer, MD
Vice Chair and Director of the Family Medicine Residency Program
University of Miami Miller School of Medicine
Chief of Service for Family Medicine
University of Miami Hospital
Matthew Schocket, MD
Anesthesiologist and Pain Management Specialist
Capitol Pain Institute
This enduring material activity, Principles of Neuropathic Pain Assessment and Management, (the first activity in the Neuropathic Pain series), has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. This activity conforms to the AAFP criteria for evidence-based CME clinical content. AAFP accreditation begins November 15, 2011. Term of approval is for two year(s) from this date with the option of yearly renewal.
The evidence-based CME content developed for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.
The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Academy of Family Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Introduction and Opening Remarks
Module 1. Understanding Neuropathic Pain
Module 2. Neuropathic Pain Syndromes
Module 3. Assessment and Diagnosis of Neuropathic Pain
Module 4. Treatment of Neuropathic Pain
It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and, if identified, they are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.
The AAFP and MedEd Architects, LLC staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Drs. Marcus and Schocket returned disclosure forms indicating that they have no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material. Dr. Tenzer returned a disclosure form indicating that she has served as a consultant to Forest Pharmaceuticals, Inc., on the topic of fibromyalgia and to Zogenix on the topic of pain.