by Giorgio Cruccu
The International Association for the Study of Pain (IASP) has launched the Global Year Against Neuropathic Pain on 20 October 2014. The Neuropathic Pain Year is intended to last till the end of 2015 (it seems to be a really special year that lasts 15 months!).
The aims are:
1. Disseminate information about neuropathic pain worldwide
2. Educate pain researchers and health-care professionals who see the issues associated with neuropathic pain firsthand in their interactions with patients
3. Increase awareness of neuropathic pain among government officials, members of the media, and the general public worldwide
4. Encourage government leaders, research institutions, and others to support policies that result in improved pain treatment for people with neuropathic pain
Because the initiative is meant to mobilize IASP members and chapters and forge partnerships with other organizations in the field, such as the EAN, I herewith promote this issue on Neuropenews.
What is neuropathic pain?
According to the latest definition, it is pain that arises as a direct consequence of a lesion or disease affecting the somatosensory system [1]. Neuropathic pain typically manifests with continuous pain (burning, squeezing, pressure) or paroxysmal pain (electric shock-like sensations, stabbing pain), and provoked (brush-evoked, pressure-evoked, cold-evoked), or paraesthetic and dysaesthesic (tingling, pins and needles) sensations.
Which are the most common conditions?
From distal to proximal: distal symmetrical peripheral neuropathies (such as diabetic neuropathy) and focal neuropathies related to trauma (such as traumatic brachial plexus injuries), and following surgical interventions (such as breast surgery). CNS diseases that commonly cause neuropathic pain include multiple sclerosis, spinal cord injury and stroke. To tell the truth, central post-stroke pain (or “thalamic pain”) is less frequent than commonly believed: only 8% of patients who had a brain infarction develop a real neuropathic pain. They may indeed suffer from pain, but most often their pain is secondary to the postural changes induced by motor weakness or spasticity) [2].
According to the latest surveys, the prevalence of Neuropathic pain is about 8% of the general European population. The economic and social burden for the health care systems is terrible. For many patients the physical and psychological suffering can be even worse. So far, the most reliable estimates conclude that less than 50% of patients with neuropathic pain achieve >50% pain relief using any drug or their combination [3].
I believe that neurologists should become more and more aware of neuropathic pain because the field is very difficult and neurologists have the right anatomical-physiological knowledge to master the many pathophysiological mechanisms that are involved [4].
Next time your neurological patient also complains of pain, please think of it.
References:
- Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008; 70:1630-5.
- Klit H, Hansen AP, Marcussen NS, Finnerup NB, Jensen TS. Early evoked pain or dysesthesia is a predictor of central poststroke pain. Pain 2014. pii: S0304-3959(14)00475-8. doi: 10.1016/j.pain.2014.09.037.
- Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T; European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010; 17:1113-e88.
- Truini A, Garcia-Larrea L, Cruccu G. Reappraising neuropathic pain in humans—how symptoms help disclose mechanisms. Nat Rev Neurol. 2013; 9:572-82.
Professor Giorgio Cruccu works at the Department of Neurology and Psychiatry, at the University of Rome “La Sapienza”, Italy
