Can pain can be more or less neuropathic? Comparison of symptom assessment tools with ratings of certainty by clinicians
Abstract
Chronic pain is generally regarded as being divided into two mutually exclusive pain mechanisms: nociceptive and neuropathic. Recently, this dichotomous approach has been questioned and a model of chronic pain being 'more or less neuropathic' has been suggested. To test whether such a spectrum exists, we examined responses by patients with chronic pain to validated neuropathic pain assessment tools and compared these with ratings of certainty about the neuropathic origin of pain by their specialist pain physicians. We examined 200 patients (100 each with nociceptive and neuropathic pain) and administered the self-complete Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS score) and the Neuropathic Pain Scale (NPS). Clinicians were asked to rate their certainty of the presence of neuropathic pain mechanisms on a 100 mm visual analogue scale (VAS) (0='not at all neuropathic in origin' to 100='completely neuropathic in origin'). The whole sample was divided into tertiles based on ascending ratings of diagnostic certainty by clinicians using the VAS and labelled 'unlikely', 'possible' and 'definite' neuropathic pain. There were significant differences in median S-LANSS and NPS composite scores between all tertile groups. There were also significant differences between many S-LANSS and NPS item scores between groups. We have shown that higher scores on both the S-LANSS and the NPS are indicative of greater clinician certainty of neuropathic pain mechanisms being present. These data support the theoretical construct that pain can be more or less neuropathic and that pain of predominantly neuropathic origin may be a useful clinical concept.
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While pain type is broadly either nociceptive or neuropathic, many pains are mixed, requiring multi-modal pharmacology.
“While pain type is broadly either nociceptive or neuropathic, many pains are mixed, requiring multi-modal pharmacology [43].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [43]
Recent studies call into question the good tolerability and efficacy of paracetamol, and circumspection is needed about even this basic treatment.
“However, recent studies call this into question, and we need a degree of circumspection about even this basic treatment [16, 43].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [43]
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Self-citation
- Authors
- Bennett, M. I., Smith, B. H., Torrance, N., & Lee, A. J.
- Affiliations
- University of Aberdeen (GB)
- Venue
- Pain
- Published
- 2006-06
- Volume
- 122
- Issue
- 3
- Pages
- 289-294
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W1965309584
- Cited by
- 169
- References
- 18
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 10 · 2015: 8 · 2014: 11 · 2013: 17 · 2012: 14
- FWCI
- 8.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion)
- Funders
- Pfizer UK
- 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, nociceptive pain, pain mechanisms, Leeds Assessment of Neuropathic Symptoms and Signs, symptom assessment tools
- MeSH terms
- Chronic Disease, Diagnostic Techniques, Neurological, Female, Humans, Male, Middle Aged, Neuralgia, Nociceptors, Pain, Pain Measurement, Severity of Illness Index
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