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EFNS guidelines on neuropathic pain assessment: revised 2009
1Department of Neurological Sciences, La Sapienza University, Rome, Italy. cruccu@uniroma1.it
European Journal of Neurology
|March 20, 2010
Summary
Revised European guidelines offer updated recommendations for diagnosing neuropathic pain (NP). New definitions, validated screening tools, and laboratory tests like laser-evoked potentials (LEPs) enhance NP assessment.
Area of Science:
- Neurology
- Pain Medicine
- Clinical Diagnostics
Background:
- Previous European Federation of Neurological Societies (EFNS) guidelines on neuropathic pain (NP) assessment required revision.
- The existing guidelines covered diagnostic processes, screening tools, quantitative sensory testing (QST), microneurography, pain-related reflexes, evoked potentials, functional neuroimaging, and skin biopsy.
Purpose of the Study:
- To revise the EFNS guidelines on neuropathic pain (NP) assessment.
- To provide updated recommendations for the diagnostic process, screening tools, and laboratory investigations for NP.
Main Methods:
- Literature review and rating of studies published between 2004 and 2009.
- Application of the EFNS method for classifying diagnostic procedures.
Main Results:
- Most prior recommendations were supported by new evidence.
- Key revisions include a new definition of NP and a diagnostic grading system.
- Introduction of new validated clinical screening tools and questionnaires for NP components and types.
- Inclusion of recent high-quality studies on laser-evoked potentials (LEPs) and skin biopsy.
Conclusions:
- Clinical history and bedside examination remain crucial for NP diagnosis.
- Screening tools and questionnaires aid in identifying probable NP.
- Quantitative sensory testing (QST) is valuable for NP identification and treatment response assessment.
- Laser-evoked potentials (LEPs) are optimal for assessing Adelta pathway dysfunction.
- Skin biopsy is effective for diagnosing neuropathies with distal unmyelinated nerve fiber loss.
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