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Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Outcomes from the NeuPSIG working group
Open accessAbstract
Pain radiating from the spine into the leg is commonly referred to as “sciatica,” “Sciatica” may include various conditions such as radicular pain or painful radiculopathy. It may be associated with significant consequences for the person living with the condition, imposing a reduced quality of life and substantial direct and indirect costs. The main challenges associated with a diagnosis of “sciatica” include those related to the inconsistent use of terminology for the diagnostic labels and the identification of neuropathic pain. These challenges hinder collective clinical and scientific understanding regarding these conditions. In this position paper, we describe the outcome of a working group commissioned by the Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain (IASP) which was tasked with the following objectives: (1) to revise the use of terminology for classifying spine-related leg pain and (2) to propose a way forward on the identification of neuropathic pain in the context of spine-related leg pain. The panel recommended discouraging the term “sciatica” for use in clinical practice and research without further specification of what it entails. The term “spine-related leg pain” is proposed as an umbrella term to include the case definitions of somatic referred pain and radicular pain with and without radiculopathy. The panel proposed an adaptation of the neuropathic pain grading system in the context of spine-related leg pain to facilitate the identification of neuropathic pain and initiation of specific management in this patient population.
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“To indicate probable neuropathic pain, pain must also be associated with sensory abnormalities (i.e., clinical signs such as allodynia and/or hyperalgesia) in the same neuroanatomical plausible distribution (Finnerup et al. 2016; Schmid et al. 2023).”
From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the NeuPSIG Algorithm (2026) · cites this paper as Schmid et al. 2023
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“the Neuropathic Pain Special Interest Group (NeuPSIG) has developed a grading system for the identification of neuropathic pain (Finnerup et al. 2016; Schmid et al. 2023)”
From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the NeuPSIG Algorithm (2026) · cites this paper as Schmid et al. 2023
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“To indicate possible neuropathic pain, patients must meet two criteria. First, the medical history should prompt a possible explanation for neuropathic pain, and patients should present with clinical symptoms. Second, the experienced pain distribution must be neuroanatomically plausible (i.e., the experienced pain is likely to correspond to the patient's neurological damage) (Finnerup et al. 2016;”
From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the NeuPSIG Algorithm (2026) · cites this paper as Schmid et al. 2023
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“Lastly, to establish definite neuropathic pain, additional objective confirmation of a lesion or disease in the somatosensory nervous system that may explain the pain is required (Finnerup et al. 2016; Schmid et al. 2023).”
From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the NeuPSIG Algorithm (2026) · cites this paper as Schmid et al. 2023
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Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles
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Self-citationUsing screening tools to identify neuropathic pain
Bennett, M., Attal, N., Bačkonja, M., Baron, R., Bouhassira, D., Freynhagen, R., Scholz, J., Tölle, T. R., Wïttchen, H., & Jensen, T. S. (2006) · Pain · doi:10.1016/j.pain.2006.10.034 · Cited by 586
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Self-citationPain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis
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ON DISTURBANCES OF SENSATION WITH ESPECIAL REFERENCE TO THE PAIN OF VISCERAL DISEASE
Head, H. H. (1893) · Brain · doi:10.1093/brain/16.1-2.1 · Cited by 395
Research works printed but not linked: 1
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Cashin, A. G., Furlong, B., Kamper, S. J., Carvalho, D. E. D., Machado, L. A. C., Davidson, S. R. E., Bursey, K., Shaheed, C. A., & Hall, A. M. (2025) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2024-112974 · Cited by 43
de Zoete, R. M. J. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12227108 · Cited by 29
Analgesia for non-specific low back pain
Jones, C. M. P., Underwood, M., Chou, R., Schoene, M., Sabzwari, S., Cavanagh, J., & Lin, C.-W. C. (2024) · BMJ · doi:10.1136/bmj-2024-080064 · Cited by 21
Self-citationLiu, T., & Zhang, L. (2025) · Journal of Neuroimmune Pharmacology · doi:10.1007/s11481-025-10172-y · Cited by 12
Neurological examination for cervical radiculopathy: a scoping review
Yousif, M. S., Occhipinti, G., Bianchini, F., Feller, D., Schmid, A. B., & Mourad, F. (2025) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-025-08560-9 · Cited by 12
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Metadata
- Authors
- Schmid, A. B., Tampin, B., Baron, R., Finnerup, N. B., Hansson, P., Hietaharju, A., Konstantinou, K., Lin, C.-W. C., Markman, J., Price, C., Smith, B. H., & Slater, H.
- Affiliations
- University of Oxford (GB)
- Curtin University (AU)
- University Hospital Schleswig-Holstein (DE)
- Aarhus University (DK)
- Oslo University Hospital (NO)
- Tampere University (FI)
- Midlands Partnership NHS Foundation Trust (GB)
- The University of Sydney (AU)
- University of Rochester Medicine (US)
- University of Dundee (GB)
- Corresponding author
- Schmid, Annina B.
- ORCID
- Venue
- Pain
- Published
- 2023-05-25
- Volume
- 164
- Issue
- 8
- Pages
- 1693-1704
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- PMC
- PMC10348639
- OpenAlex
- W4378373890
- Cited by
- 51
- References
- 76
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 11 · 2023: 5
- FWCI
- 9.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Pain (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion, cc-by)
- Library Osnabrück University (Hochschule Osnabrück) (submittedVersion, cc-by)
- Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by)
- Funders
- International Association for the Study of Pain
- Wellcome Trust (222101, 222101/Z/20/Z)
- National Institute for Health and Care Research
- Lundbeckfonden (R359-2020 2620)
- H. Lundbeck A/S
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- sciatica, neuropathic pain, radicular pain, radiculopathy, pain terminology, diagnostic classification
- MeSH terms
- Humans, Leg, Neuralgia, Quality of Life, Radiculopathy, Sciatica
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