Neuropathic Pain: Enhancing Assessment and Management Skills
Between 18 and 30 million Americans report chronic pain with neuropathic characteristics.1-3 In primary care, 60 to 80 of every 1,000 patients present with symptoms of chronic neuropathic pain.4 Despite these high numbers, neuropathic pain continues to present diagnostic and management challenges.
Neuropathic pain is difficult to differentiate from other chronic pain conditions in part because patients often have trouble describing the unique characteristics of neuropathic pain.5,6 Furthermore, neuropathic pain is more complicated to treat than other types of chronic pain.7-9 Finding an effective regimen requires a trial-and-error approach that can be frustrating to both physician and patient.7
This two-part series demonstrates practical, evidence-based strategies for assessment, diagnosis and management of neuropathic pain, using faculty discussions and case studies to reinforce learning points. Downloadable resources offer easy access to evidence-based recommendations, references and practice tools.
- Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population study. J Pain 2006;7:281-9.
- Bouhassira D, Lanteri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008;136:380-7.
- Yawn BP, Wollan PC, Weingarten TN, Watson JC, Hooten WM, Melton LJ 3rd. The prevalence of neuropathic pain: clinical evaluation compared with screening tools in a community population. Pain Med 2009;10(3):586–93.
- McDermott AM, Toelle TR, Rowbotham DJ, Schaefer CP, Dukes EM. The burden of neuropathic pain: Results of a cross-sectional survey. Eur J Pain 2006;10:127-35.
- Galer BS, Gianas A, Jansen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract 2000;47:123-8.
- Smith EM, Beck SL, Cohen J. The total neuropathy score: a tool for measuring chemotherapy-induced peripheral neuropathy. Oncol Nurs Forum 2008;35:96-102.
- 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.
After completing this two-part series, 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 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.
Activity 1: Principles of Neuropathic Pain Assessment and Management
Activity 2: Tailoring the Treatment of Neuropathic Pain: Case Studies
Acknowledgement of Support
These activities are supported by an independent educational grant from Pfizer and PriCara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC.