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Incontro Nazionale Neurofisiologia: Nuove Strategie “ Controversie sulla diagnosi e terapia del dolore neuropatico ” Palermo, 29-30 novembre 2012.

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Incontro Nazionale Neurofisiologia: Nuove Strategie


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slide1

Incontro Nazionale Neurofisiologia:

Nuove Strategie

“Controversie sulla diagnosi e terapia del dolore neuropatico”

Palermo, 29-30 novembre 2012

Gli Strumenti di Screening devono essereapplicati nella diagnosi di DN?Si  Nadine AttalNo  SandriniDiscussantBrigida Fierro, Angelo Quartarone

premesse il topic brigida fierro dipartimento bionec universit degli studi di palermo

Premesse: Il TopicBrigida FierroDipartimento BioNec Università degli studi di Palermo

Palermo, 29-30 novembre 2012

neuropathic pain definition
Neuropathic Pain: definition

Neurology. 2008 Apr 29;70(18):1630-5. Epub 2007 Nov 14.

Neuropathic pain: redefinition and a grading system for clinical and research purposes.

Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J.

The International Association for the Study of Pain (IASP 1994) introduced the term neuropathic pain, defined as "pain initiated or caused by a primary lesion or dysfunction in the nervous system." While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain, it lacks defined boundaries.

The Neurophatic pain Special interest group (NeuPSIG 2008) present a more precise definition : pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.

so including a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain.

Palermo, 29-30 novembre 2012

slide5

Neuropathic Pain

The challenge is:

  • to differentiate neuropathic pain from other types of pain

and then

  • to diagnose the lesion or disease causing the pain.

Palermo, 29-30 novembre 2012

slide6

Methods of assessing nerve function

(1) bedside examination, which relies on the physician's experience and the patient's ability and willingness to collaborate;

(2) quantitative sensory testing, a measure that despite using quantitative, graded stimuli also relies on the patient's evaluation;

(3) laboratory tests use quantitative tools and measure an objective responses.

slide7

Neuropathic Pain

The challenge is:

first step

  • to differentiate neuropathic pain from other types of pain

and then

  • to diagnose the lesion or disease causing the pain.

Palermo, 29-30 novembre 2012

grading system of neuropathic pain neupsig 2008
Grading system of neuropathic pain (NeuPSIG 2008)

Treede et al Neurology 2008

Palermo, 29-30 novembre 2012

slide9

Neuropathic vs. nociceptive Pain

Pain is a subjective condition that cannot be objectively measured; for this reason, self patient-perspective is crucial to evaluate:

  • character (quality, intensity,temporal aspects, stimulus-dependent or not etc.)
  • distribution of pain (confined to innervation territory of the affected nervous structure)
  • Presence of positive or negative symptoms or signs.
slide10

Screening tools

recently, several screening tools have been developedessentially to discriminate between nociceptive and neuropathic pain

Based on pain descriptors

modern screening tools
Modern Screening tools

Palermo, 29-30 novembre 2012

slide12

Le Douleur Neuropathique 4 DN4: Italian Version

Interview

Subjective measures

Physician

Examination

se il punteggio del paziente è uguale o maggiore di 4/10, il test è positivo (sensibilità=82,9%; specificità=89,9%)

Bouhassira et., 2005; versione italiana a cura di Caraceni, Zecca e Martini)

slide13

Screening tools

Pearls

Pitfalls

  • identifypatients with possibleneuropathicpain.
  • are easy to use
  • provideimmediatelyavailableinformations
  • are useful for researchpourposes
  • fail to identify abot 10-20% of patients with clinical diagnosed neuropahic pain

so

  • cannot replace clinical judgment
screening tools
Screening Tools

The questions are:

  • are they useful in the real life or only for clinical trials?
  • do they identify subtypes of neuropathic pain?
  • can they be used to assess the effects of treatment?
  • should also be used to predict treatment outcome and better define responder profiles to treatment?