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Identification of neuropathic pain in patients with neck/upper limb pain: application of a grading system and
Brigitte Tampin1, Noelle Kathryn Briffa, Roger Goucke
1School of Physiotherapy and Excercise Science, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Department of Pain Management, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Pain Medicine Unit, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
Abstract:
The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic pain (NeP) using the following categories: no NeP, possible, probable, or definite NeP. To further evaluate this system, we investigated patients with neck/upper limb pain with a suspected nerve lesion, to explore: (i) the clinical application of this grading system; (ii) the suitability of 2 NeP questionnaires (Leeds Assessment of Neuropathic Symptoms and Signs pain scale [LANSS] and the painDETECT questionnaire [PD-Q]) in identifying NeP in this patient cohort; and (iii) the level of agreement in identifying NeP between the NeuPSIG classification system and 2 NeP questionnaires. Patients (n = 152; age 52 ± 12 years; 53% male) completed the PD-Q and LANSS questionnaire and underwent a comprehensive clinical examination. The NeuPSIG grading system proved feasible for application in this patient cohort, although it required considerable time and expertise. Both questionnaires failed to identify a large number of patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD-Q sensitivity 64%, specificity 62%). These lowered sensitivity scores contrast with those from the original PD-Q and LANSS validation studies and may reflect differences in the clinical characteristics of the study populations. The diagnostic accuracy of LANSS and PD-Q for the identification of NeP in patients with neck/upper limb pain appears limited.
