Assessment of Neuropathic Pain in Primary Care
Abstract
Management of patients presenting with chronic pain is a common problem in primary care. Essentially, the classification of chronic pain falls into 3 broad categories: (1) pain owing to tissue disease or damage (nociceptive pain), (2) pain caused by somatosensory system disease or damage (neuropathic pain), and (3) pain without a known somatic background. Key challenges in developing a targeted holistic approach to treatment include appropriate diagnosis of the cause or causes of pain; identifying the type of pain and assessing the relative importance of its various components; and determining appropriate treatment. In clinical examination, sensory abnormalities are the crucial findings leading to a diagnosis of neuropathic pain, for which pharmacotherapy with antidepressants and anticonvulsants represents the cornerstone of medical treatment. Chronic neuropathic pain is underrecognized and undertreated, yet primary care physicians are uniquely placed on the frontlines of patient management, where they can play a pivotal role in treatment and prevention through diagnosis, therapy, follow-up, and referral. This review provides guidance in understanding and identifying the neuropathic contribution to pain presenting in primary care; assessing its severity through patient history, physical examination, and appropriate diagnostic tests; and establishing a rational treatment plan.
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Tools such as the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Neuropathic Pain Diagnostic Questionnaire (DN4), the Neuropathic Pain Questionnaire (NPQ), ID Pain and PainDETECT are useful in determining whether pain is likely to be neuropathic, an important factor in determining subsequent management.
“Tools such as the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Neuropathic Pain Diagnostic Questionnaire (DN4) the Neuropathic Pain Questionnaire (NPQ), ID Pain and PainDETECT are useful in determining whether pain is likely to be neuropathic, an important factor in determining subsequent management [27].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [27]
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- Authors
- Haanpää, M. L., Backonja, M.-M., Bennett, M. I., Bouhassira, D., Cruccu, G., Hansson, P. T., Jensen, T. S., Kauppila, T., Rice, A. S. C., Smith, B. H., Treede, R.-D., & Baron, R.
- Affiliations
- Helsinki University Hospital (FI)
- Hôpital Ambroise-Paré (FR)
- Sapienza University of Rome (IT)
- Karolinska University Hospital (SE)
- Aarhus University Hospital (DK)
- University of Helsinki (FI)
- Chelsea and Westminster Hospital (GB)
- University of Aberdeen (GB)
- Heidelberg University (DE)
- University Hospital Schleswig-Holstein (DE)
- Corresponding author
- Haanpää, Maija L.
- ORCID
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 122
- Issue
- 10
- Pages
- S13-S21
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2151294448
- Cited by
- 223
- References
- 53
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 11 · 2023: 3 · 2022: 11 · 2021: 4 · 2020: 13 · 2019: 16 · 2018: 18 · 2017: 12 · 2016: 12 · 2015: 8 · 2014: 21 · 2013: 27 · 2012: 21
- FWCI
- 14.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- neuropathic pain, chronic pain, primary care, pain assessment, nociceptive pain, sensory disturbances, antidepressants, antiepileptic drugs, pain diagnosis
- MeSH terms
- Adult, Diagnosis, Differential, Evoked Potentials, Somatosensory, Female, Humans, Lymph Node Excision, Mastectomy, Medical History Taking, Middle Aged, Neuralgia, Pain, Pain Measurement, Physical Examination, Primary Health Care, Severity of Illness Index, Thermosensing, Touch, Vibration, Stavudine, Reverse Transcriptase Inhibitors, Anti-HIV Agents
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