Revised Definition of Neuropathic Pain and Its Grading System: An Open Case Series Illustrating Its Use in Clinical Practice

Geber, Christian; Baumgärtner, Ulf; Schwab, Rainer; Müller, Harald; Stoeter, Peter; Dieterich, Marianne; Sommer, Clemens; Birklein, Frank; Treede, Rolf-Detlef

doi:10.1016/j.amjmed.2009.04.005

« Previous Next »The American Journal of Medicine
Volume 122, Issue 10, Supplement , Pages S3-S12, October 2009

Revised Definition of Neuropathic Pain and Its Grading System: An Open Case Series Illustrating Its Use in Clinical Practice

Christian Geber, Dr.med.
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
Ulf Baumgärtner, Dr.med.
- Department of Neurophysiology, Center for Biomedicine and Medical Technology–Mannheim, Heidelberg University, Mannheim, Germany
Rainer Schwab, Dr.med.
- Anesthesia Clinic and Polyclinic, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
Harald Müller, Dr.med.
- Institute for Neuropathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
Peter Stoeter, Dr.med.
- Institute for Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
Marianne Dieterich, Dr.med.
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
Clemens Sommer, Dr.med.
- Institute for Neuropathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
Frank Birklein, Dr.med.
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
Rolf-Detlef Treede, Dr.med.
- Department of Neurophysiology, Center for Biomedicine and Medical Technology–Mannheim, Heidelberg University, Mannheim, Germany
- Requests for reprints should be addressed to Rolf-Detlef Treede, MD, Department of Neurophysiology, Center for Biomedicine and Medical Technology–Mannheim, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Strasse 13-17, 68167 Mannheim, Germany

Abstract

The definition of neuropathic pain has recently been revised by an expert committee of the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) as “pain arising as direct consequence of a lesion or disease affecting the somatosensory system,” and a grading system of “definite,” “probable,” and “possible” neuropathic pain has been introduced. This open case series of 5 outpatients (3 men, 2 women; mean age 48 ± 12 years) demonstrates how the grading system can be applied, in combination with appropriate confirmatory testing, to diagnosis neuropathic conditions in clinical practice. The proposed grading system includes a dynamic algorithm that enhances the physician's ability to determine with a greater level of certainty whether a pain condition is neuropathic. Its clinical use should be further validated in prospective studies.

Keywords: Cerebrospinal fluid analysis, Laser-evoked potentials, Neurography, Neuroimaging, Quantitative sensory testing, Skin biopsy