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Assessment of Nerve Pain

Neuropathic pain is very different from Nociceptive (or inflammatory) pain. While nociceptive pain is often produced by tissue damage, abnormally stimulated nerves are believed to play a key role in neuropathic pain; this can result from nerve damage caused by trauma or certain conditions.

Neuropathic pain is a common condition that can be easy to miss or overlooked.  The average GP may have between 35-70 patients with neuropathic pain for whom appropriate treatments may be uncomplicated and can be started early in primary care.

 

Recognising and Diagnosing Neuropathic Pain

 There are many possible causes of neuropathic pain. Most common causes of neuropathic pain are diabetes, herpes zoster, trigeminal neuralgia and sugery eg post hernia repair.  However, because many pain types can have a component of neuropathic (nerve) pain it is important to think about whether this is the case when assessing patients' pain.  There are a number of clues that can help with this, many of which depend on how the pain is felt and what character it has.  

The language often used to describe neuropathic pain include words such as burning, stabbing, shooting, tingling and electric-shock like.

Some of the sensations that can be associated with neuropathic pain can be useful in suggesting the diagnosis:

  • Allodynia: pain produced by an innocuous stimulus e.g. touch or pressure.  Often gives sensations that people describe as "stinging nettles", "like a scald" or "barbed wire".
  • Hyperaesthesia: increased sensitivity to touch
  • Hyperalgesia: increased response to a normally painful stimulus
  • Dysaesthesia: an unpleasant abnormal sensation

Some of these symptoms and descriptors are drawn together in questionnaires that can be useful in assessing pain, such as the McGill Pain Questionnaire or a simpler questionnaire derived from it called the Short-Form McGill Pain Questionnaire.

There are also several useful rating scales which can be helpful in making this assessment.  In particular, the PainDETECT scale, DN4 (Douleur Neuropathique 4) and Leeds Assessment of Neuropathic Symptoms Scales (LANSS or s-LANSS).

 

 

 

 

 

 

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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk

Page updated 15/02/2016