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Cited by 113Pain Mechanisms and TreatmentsPain Management and TreatmentMusculoskeletal pain and rehabilitation

Joint European Academy of Neurology–European Pain Federation–Neuropathic Pain Special Interest Group of the International Association for the Study of Pain guidelines on neuropathic pain assessment

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Truini, Andrea, Aleksovska, Katina, Anderson, Christopher C., Attal, Nadine, Baron, Ralf, Bennett, David L., Bouhassira, Didier, Cruccu, Giorgio +17 more·2023·European Journal of Neurology
DOI 10.1111/ene.15831
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Abstract

Background and Purpose: In these guidelines, we aimed to develop evidence‐based recommendations for the use of screening questionnaires and diagnostic tests in patients with neuropathic pain (NeP). Methods: We systematically reviewed studies providing information on the sensitivity and specificity of screening questionnaires, and quantitative sensory testing, neurophysiology, skin biopsy, and corneal confocal microscopy. We also analysed how functional neuroimaging, peripheral nerve blocks, and genetic testing might provide useful information in diagnosing NeP. Results: Of the screening questionnaires, Douleur Neuropathique en 4 Questions (DN4), I‐DN4 (self‐administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received a strong recommendation, and S‐LANSS (self‐administered LANSS) and PainDETECT weak recommendations for their use in the diagnostic pathway for patients with possible NeP. We devised a strong recommendation for the use of skin biopsy and a weak recommendation for quantitative sensory testing and nociceptive evoked potentials in the NeP diagnosis. Trigeminal reflex testing received a strong recommendation in diagnosing secondary trigeminal neuralgia. Although many studies support the usefulness of corneal confocal microscopy in diagnosing peripheral neuropathy, no study specifically investigated the diagnostic accuracy of this technique in patients with NeP. Functional neuroimaging and peripheral nerve blocks are helpful in disclosing pathophysiology and/or predicting outcomes, but current literature does not support their use for diagnosing NeP. Genetic testing may be considered at specialist centres, in selected cases. Conclusions: These recommendations provide evidence‐based clinical practice guidelines for NeP diagnosis. Due to the poor‐to‐moderate quality of evidence identified by this review, future large‐scale, well‐designed, multicentre studies assessing the accuracy of diagnostic tests for NeP are needed.

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  • The majority of studies meeting only possible criteria is likely because questionnaires such as DN4, PainDETECT, and LANSS are relatively easy to administer, whereas economic and professional constraints of physical and sensory examinations and objective confirmatory tests present major barriers to routine diagnostics.

    “This is likely because questionnaires such as DN4, PainDETECT, and LANSS are relatively easy to administer. In contrast, the economic and professional constraints of physical and sensory examinations, as well as objective confirmatory tests (e.g., MRI or neurophysiological techniques), present major barriers to the routine implementation of such diagnostics (Truini et al. 2023).”

    From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the <scp>NeuPSIG</scp> Algorithm (2026) · cites this paper as Truini et al. 2023

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  • In line with NeuPSIG guidelines, a possible diagnosis appears appropriate for epidemiologic purposes and for initial examinations, prompting clinicians to conduct further neurological examinations in people with multiple sclerosis.

    “In line with NeuPSIG guidelines, a possible diagnosis appears appropriate for epidemiologic purposes and for initial examinations, prompting clinicians to conduct further neurological examinations in pwMS (Truini et al. 2023).”

    From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the <scp>NeuPSIG</scp> Algorithm (2026) · cites this paper as Truini et al. 2023

    The Discussion (page unavailable) says screening questionnaires are useful in epidemiological studies and can help identify ‘possible’ neuropathic pain at the first stage of the NeuPSIG algorithm. The Introduction (page unavailable) describes sensory signs and objective tests as requirements for higher diagnostic certainty. The guidelines do not specifically recommend this approach or further neurological examinations for people with multiple sclerosis; that is the citing authors’ application of the general guidance. (LLM, conf=0.85)

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  • Most established questionnaires for distinguishing pain phenotypes were developed before the current NeuPSIG guidelines.

    “Because most established questionnaires for distinguishing pain phenotypes were developed before the current NeuPSIG guidelines, we followed their recommendations and automatically accepted a possible diagnosis of neuropathic pain when Criterion 1 was met (Truini et al. 2023).”

    From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the <scp>NeuPSIG</scp> Algorithm (2026) · cites this paper as Truini et al. 2023

  • Studies exclusively investigating people with multiple sclerosis and pain cannot accurately estimate the true prevalence of neuropathic pain, so the current review excluded such studies.

    “The current review excluded such studies, as these cannot accurately estimate the true prevalence of neuropathic pain (Truini et al. 2023).”

    From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the <scp>NeuPSIG</scp> Algorithm (2026) · cites this paper as Truini et al. 2023

    The Screening Questionnaires section says that recruitment at pain centres may explain why some studies found a higher prevalence of neuropathic pain than epidemiological studies. It does not address whether studies restricted to people with multiple sclerosis and pain can estimate neuropathic-pain prevalence. Searches for multiple sclerosis and pain-only study populations found no passage establishing the cited rationale. (LLM, conf=0.72)

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Authors
Truini, A., Aleksovska, K., Anderson, C. C., Attal, N., Baron, R., Bennett, D. L., Bouhassira, D., Cruccu, G., Eisenberg, E., Enax‐Krumova, E., Davis, K. D., Di Stefano, G., Finnerup, N. B., Garcia‐Larrea, L., Hanafi, I., Haroutounian, S., Karlsson, P., Rakusa, M., Rice, A. S. C., Sachau, J., Smith, B. H., Sommer, C., Tölle, T., Valls‐Solé, J., & Veluchamy, A.
Affiliations
  • Sapienza University of Rome (IT)
  • European Academy of Neurology (AT)
  • Washington University in St. Louis (US)
  • Inserm (FR)
  • University Hospital Schleswig-Holstein (DE)
  • University of Oxford (GB)
  • Technion – Israel Institute of Technology (IL)
  • BG University Hospital Bergmannsheil Bochum (DE)
  • University Health Network (CA)
  • Department of Human Neuroscience University Sapienza Rome Italy
  • Aarhus University (DK)
  • Central Integration of Pain (NeuroPain) Lab‐Lyon Neuroscience Research Centre, INSERM U1028, CNRS, UMR5292 Université Claude Bernard Bron France
  • Universitätsklinikum Würzburg (DE)
  • Department of Clinical Medicine, Danish Pain Research Centre Aarhus University Aarhus Denmark
  • Division of Neurology University Medical Centre Maribor Maribor Slovenia
  • Imperial College London (GB)
  • University of Dundee (GB)
  • TUM Klinikum (DE)
  • Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES)
Corresponding author
Truini, Andrea
ORCID
Venue
European Journal of Neurology
Publisher
Wiley
Published
2023-05-30
Volume
30
Issue
8
Pages
2177-2196
ISSN
  • 1351-5101 (ISSN-L)
  • 1468-1331
DOI
10.1111/ene.15831
OpenAlex
W4378781989
Cited by
113
References
5
Citations by year
2026: 33 · 2025: 35 · 2024: 40 · 2023: 5
FWCI
4.03
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Neurology (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, cc-by-nc)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by-nc)
  • Discovery Research Portal (University of Dundee) (submittedVersion, cc-by-nc)
Funders
  • Novo Nordisk Fonden (NNF14OC0011633, NNF18OC0052301)
  • Medical Research Council (MR/T020113/1)
  • Steno Diabetes Center Aarhus
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, neuropathic pain diagnosis, screening questionnaire, DN4, painDETECT, quantitative sensory testing, skin biopsy, corneal confocal microscopy, secondary trigeminal neuralgia, functional neuroimaging, peripheral nerve block, genetic testing, diagnostic accuracy
MeSH terms
Humans, Neuralgia, Public Opinion, Surveys and Questionnaires, Sensitivity and Specificity, Trigeminal Neuralgia

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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