Box 281 Common neuropathic descriptors

• Hot/burning/scalding

• Prickling, tingling

• Pins and needles

• Electrical

• Shooting/stabbing/lancinating

• Stimulus evoked pain (Sensitive to light touch, brush-up, cold)

Compiled from Stormer et al.,7 Galer and Jensen,5 Bennett,4 Krause and Backonja,3 and Bouhassira et al.2

2. Neuropathic pain can be persistent, paroxysmal, evoked, or some combination of these, independent of where the lesion exists.

3. Treatment efficacy, or lack thereof, may have as much to do with what the pain subtype is as it does to the site and etiology of the lesions. Age, metabolism, and coping/life skills, and comorbidities (depression, nonrestorative sleep, functional limitations) may affect medication response. In a field with few gold standard data to guide evidence-based recommendations, it would seem reasonable to consider a medication or interventional treatment trial for one central pain syndrome if it had shown promise or efficacy in another.

4. Non-neuropathic pain types are a common concomitant feature in patients with central neuropathic pain. Patients with central nervous system dysfunction are often neurologically and thus functionally impaired (para- or hemiparesis for example), placing a greater burden on nonimmobilized segments. The clinician needs to be aware that common processes, such as rotator cuff pathology, degenerative joint disease, or a peripheral neuropathic process (radiculopathy or ulnar neuropathy at the elbow for example), are prevalent and need to be considered when evaluating a pain disorder in a patient with a central nervous system disease.

make the diagnosis of neuropathic pain. Specifically in spinal cord injury patients, a central pain population highly prone to concomitant non-neuropathic (e.g. musculoske-letal nociceptive) pain, pain descriptors failed to effectively distinguish between neuropathic and non-neuropathic pain types.6 Similarly, the character of the neuropathic pain is not specific in distinguishing between a peripheral and central neuropathic etiology.A number of IASP definitions are important for neuropathic pain processes, whether central or peripheral:1

• paresthesia - an abnormal sensation, spontaneous or evoked;

• dysesthesia - an abnormal, unpleasant sensation, spontaneous or evoked;

• allodynia - pain caused by a generally non-noxious stimulus (e.g. light touch);

• hyperalgesia - an increased painful response to a normally painful stimulus (e.g. pin prick);

• hyperesthesia - increased sensitivity to stimulation (noxious or not), excluding the special senses;

• hyperpathia - a painful syndrome characterized by an abnormally painful reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold;

• anesthesia dolorosa - pain in an area or region that is anesthetic.

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