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.

      Affiliations

    • Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    • ,
  • Ulf Baumgärtner, Dr.med.

      Affiliations

    • Department of Neurophysiology, Center for Biomedicine and Medical Technology–Mannheim, Heidelberg University, Mannheim, Germany
    • ,
  • Rainer Schwab, Dr.med.

      Affiliations

    • Anesthesia Clinic and Polyclinic, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    • ,
  • Harald Müller, Dr.med.

      Affiliations

    • Institute for Neuropathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    • ,
  • Peter Stoeter, Dr.med.

      Affiliations

    • Institute for Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    • ,
  • Marianne Dieterich, Dr.med.

      Affiliations

    • Department of Neurology, Ludwig-Maximilians University, Munich, Germany
    • ,
  • Clemens Sommer, Dr.med.

      Affiliations

    • Institute for Neuropathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    • ,
  • Frank Birklein, Dr.med.

      Affiliations

    • Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
    • ,
  • Rolf-Detlef Treede, Dr.med.

      Affiliations

    • Department of Neurophysiology, Center for Biomedicine and Medical Technology–Mannheim, Heidelberg University, Mannheim, Germany
    • Corresponding Author InformationRequests 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

References 

  1. Bond MR, Breivik H, Jensen TS, Scholten W, Soyannwo O, Treede R-D. Pain associated with neurological conditions. In: Neurological Disorders: Public Health Challenges. Geneva: World Health Organization; 2006;p. 127–139
  2. Ertas M, Sagduyu A, Arac N, Uludag B, Ertekin C. Use of levodopa to relieve pain from painful symmetrical diabetic polyneuropathy. Pain. 1998;75:257–259
  3. Osterberg A, Boivie J, Thuomas KA. Central pain in multiple sclerosis—prevalence and clinical characteristics. Eur J Pain. 2005;9:531–542
  4. Schott GD. Pain in Parkinson's disease. Pain. 1985;22:407–411
  5. Starkstein SE, Preziosi TJ, Robinson RG. Sleep disorders, pain, and depression in Parkinson's disease. Eur Neurol. 1991;31:352–355
  6. Stiasny-Kolster K, Magerl W, Oertel WH, Moller JC, Treede RD. Static mechanical hyperalgesia without dynamic tactile allodynia in patients with restless legs syndrome. Brain. 2004;127(pt 4):773–782
  7. Fields HL, Rowbotham M, Baron R. Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiol Dis. 1998;5:209–227
  8. Merskey H, Bogduk N. Classification of Chronic Pain. Seattle, WA: IASP Press; 1994;
  9. Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003;60:1524–1534
  10. Cruccu G, Anand P, Attal N, et al. EFNS guidelines on neuropathic pain assessment. Eur J Neurol. 2004;11:153–162
  11. Hansson P. Neuropathic pain: clinical characteristics and diagnostic workup. Eur J Pain. 2002;6(suppl A):47–50
  12. Max MB. Clarifying the definition of neuropathic pain. Pain. 2002;96:406–407author reply 407-408
  13. Backonja MM. Defining neuropathic pain. Anesth Analg. 2003;97:785–790
  14. Jensen T, Sindrup S, Bach F. Test the classification of pain: reply to Mitchell Max. Pain. 2002;96:407–408
  15. Cervero F, Laird J. One pain or many pains? (A new look at pain mechanisms). News Physiol Sci. 1991;268–273
  16. Treede RD, Meyer RA, Raja SN, Campbell JN. Peripheral and central mechanisms of cutaneous hyperalgesia. Prog Neurobiol. 1992;38:397–421
  17. Finnerup N, Jensen T. Mechanisms of disease: mechanism-based classification of neuropathic pain—a critical analysis. Nat Clin Pract Neurol. 2006;2:107–115
  18. Scadding J, Koltzenburg M. Neuropathic pain. In:  McMahon S,  Koltzenburg M editor. Wall and Melzack's Textbook of Pain. 5 edition. Edinburgh: Churchill Livingstone; 2005;p. 973–999
  19. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630–1635
  20. International Headache Society. The International Classification of Headache Disorders, 2nd edition (ICHD-II). Cephalalgia. 2004;24(suppl 1):1–160
  21. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983;13:227–231
  22. McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the Diagnosis of Multiple Sclerosis. Ann Neurol. 2001;50:121–127
  23. Hansson P, Lacerenza M, Marchettini P. Aspects of clinical and experimental neuropathic pain: the clinical perspective. In:  Hansson PT,  Fields HL,  Hill RG,  Marchettini P editor. Neuropathic Pain: Pathophysiology and Treatment. Seattle: IASP Press; 2001;p. 1–18Progress in Pain Research and Management, vol 21
  24. Rolke R, Magerl W, Campbell KA, et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006;10:77–88
  25. Deuschl G, Eisen A. Recommendations for the Practice of Clinical neurophysiology: Guidelines of the International Federation of Clinical Neurophysiology. 2 edition. New York: Elsevier; 1999;
  26. Spiegel J, Hansen C, Treede RD. Clinical evaluation criteria for the assessment of impaired pain sensitivity by thulium-laser evoked potentials. Clin Neurophysiol. 2000;111:725–735
  27. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160–172
  28. Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms. Pain. 2006;122:264–270
  29. Zanette G, Marani S, Tamburin S. Proximal pain in patients with carpal tunnel syndrome: a clinical-neurophysiological study. J Peripher Nerv Syst. 2007;12:91–97
  30. Cruccu G, Leandri M, Iannetti GD, et al. Small-fiber dysfunction in trigeminal neuralgia: carbamazepine effect on laser-evoked potentials. Neurology. 2001;56:1722–1726
  31. Baron R, Binder A. How neuropathic is sciatica? (The mixed pain concept [in German]). Orthopade. 2004;33:568–575
  32. Freynhagen R, Rolke R, Baron R, et al. Pseudoradicular and radicular low-back pain—a disease continuum rather than different entities? (Answers from quantitative sensory testing). Pain. 2008;135:65–74
  33. Wu G, Ringkamp M, Hartke TV, et al. Early onset of spontaneous activity in uninjured C-fiber nociceptors after injury to neighboring nerve fibers. J Neurosci. 2001;21:RC140
  34. Seltzer Z, Dubner R, Shir Y. A novel behavioral model of neuropathic pain disorders produced in rats by partial sciatic nerve injury. Pain. 1990;43:205–218
  35. Kim SH, Chung JM. An experimental model for peripheral neuropathy produced by segmental spinal nerve ligation in the rat. Pain. 1992;50:355–363
  36. Bennett GJ, Xie YK. A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man. Pain. 1988;33:87–107
  37. Freynhagen R, Baron R, Gockel U, Tolle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22:1911–1920
  38. Bennett MI, Attal N, Backonja MM, et al. Using screening tools to identify neuropathic pain. Pain. 2007;127:199–203
  39. Leffler AS, Hansson P. Painful traumatic peripheral partial nerve injury-sensory dysfunction profiles comparing outcomes of bedside examination and quantitative sensory testing. Eur J Pain. 2008;12:397–402
  40. Spiegel J, Hansen C, Baumgartner U, Hopf HC, Treede RD. Sensitivity of laser-evoked potentials versus somatosensory evoked potentials in patients with multiple sclerosis. Clin Neurophysiol. 2003;114:992–1002
  41. Polydefkis M, Hauer P, Sheth S, Sirdofsky M, Griffin JW, McArthur JC. The time course of epidermal nerve fibre regeneration: studies in normal controls and in people with diabetes, with and without neuropathy. Brain. 2004;127(pt 7):1606–1615

 This work was supported by BMBF Grant No. 01EM0506 from the German Network on Neuropathic Pain (DFNS).

 Statement of author disclosure: Please see the Author Disclosures section at the end of this article.

PII: S0002-9343(09)00394-5

doi: 10.1016/j.amjmed.2009.04.005

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

Article Tools

* Image Usage & Resolution