Assessment and diagnosis of neuropathic pain

Classification of neuropathic pain has been based on disease entities, anatomical localization or histological observations. There is now recognition from clinical investigations that neuropathic pain is not a monolithic entity, but instead presents as a composite of pain and other sensory symptoms.

Attempts are underway to supplement the traditional classification with a classification that links pain and sensory symptoms with neurobiological mechanisms. This mechanism or symptom-based classification takes negative and positive sensory symptoms into account. By using a battery of standardized quantitative sensory tests the characteristic profile of sensory symptoms can be elucidated in each patient with a bedside assessment. These procedures can be fostered by apparative neurophysiological analysis, imaging techniques and biopsies. Moreover, in questionnaires verbal descriptors can depict the quality and intensity of the individual pain. They have proven to be sensible screening tools for neuropathic pain components.

Application of quantitative sensory testing and questionnaires can aid in more versatile descriptions of neuropathic pain symptoms. If it were possible to characterize the concert of the distinct mechanisms and symptoms that operate in one individual patient, an optimal polypharmacotherapy that addresses the specific combinations of mechanisms may be established for each patient.