Neuropathic Pain Scale

The Peripheral Neuropathy Solution

Peripheral Neuropathy Solution By Dr. Randall Labrum

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Thie NPS (Exhibit 15.1) was developed as a result of two research protocols in which pain descriptors were assessed for four different pain conditions: PHN, CRPS, PDN, and traumatic peripheral nerve injury. A second, more diverse group of patients being treated with either lidocaine or phentolamine infusions used the scale to rate their pain. Interestingly, the second protocol outcome identified a positive response for pain that was described as "unpleasant or deep." This finding led researchers to believe that the descriptors that are used by patients are really clues to the specific mechanisms that are producing the pain. More research is needed to correlate the various descriptors with individual mechanisms.

Thie NPS is a 10-item scale using an 11-point Likert-like rating scale where 0 indicates not sensitive, itchy, and dull, and 10 indicates the most sensitive, itchy, and dull.

It is a reliable and valid tool for measuring neuropathic pain, and it can also differentiate between nociceptive and neuropathic pain. The higher the score, the more intense the neuropathic pain.

In a study of chronic pain patients having a nociceptive or neuropathic pain condition, the NPS was used to differentiate the two pain types by score. The score of 5.53 was determined to be the cutoff point that delineated nociceptive from neuropathic type pain. Nociceptive pain types, such as myofascial syndrome, had a score of 3.81, whereas CRPS I and II had scores of 6.87 and 9.34, respectively. These results reinforce the original findings of higher NPS scores, indicating a neuropathic pain syndrome. Advantages of the NPS are as follows:

■ Two items that measure the global dimensions of pain intensity and pain unpleasantness

■ One item that addresses the fluctuation of pain from constant with intermittent increases, that are intermittently constant with fluctuation

■ Higher scores indicative of a pain that is more neuropathic

■ Can measure the effects of treatments

Exhibit 15.1

NEUROPATHIC PAIN SCALE© (NPS©)

Instructions: There are several different aspects of pain which we are interested in measuring: pain sharpness, heat/cold, dullness, intensity overall unpleasantness, and surface vs. deep pain.

The distinction between these aspects of pain might be clearer if you think of taste. For example, people might agree on how sweet a piece of pie might be (the intensity of the sweetness) but some might enjoy it more if it were sweeter while others might prefer it to be less sweet. Similarly, people can judge the loudness of music and agree on what is more quiet and what is louder, but disagree on how it makes them feel. Some prefer quiet music and some prefer it more loud. In short, the intensity of a sensation is not the same as how it makes you feel. A sound might be unpleasant and still be quiet (think of someone grating their fingernails along a chalkboard). A sound can be quiet and "dull" or loud and "dull".

Pain is the same. Many people are able to tell the difference between many aspects of their pain: for example, how much it hurts, and how unpleasant or annoying it is. Although often the intensity of pain has strong influence on how unpleasant the experience of pain is, some people are able to experience more pain than others before they feel very bad about it.

There are scales for measuring different aspects of pain. For one patient, a pain might feel extremely hot, but not at all dull, while another patient may not experience any heat, but feel like their pain is very dull. We expect you to rate very high on some of the scales below, and very low on others. We want you to use the measures that follow to tell us exactly what you experience.

Place an "X" through the number that best describes your pain.

1. Please use the scale below to tell us how intense your pain is.

012 3 4 5 6 7 8 910 pain pain sensation imaginable

2. Please use the scale below to tell us how sharp your pain feels. Words used to describe "sharp" feelings include "like a knife", "like a spike", "like a spike", or "like jolts".

Not The most sharp sharp I I I I I I I I I I I I sensation imaginable

3. Please use the scale below to tell us how hot your pain feels. Words used to describe very hot pain include "burning" and "on fire".

Not The most hot hot I 0 I 1 I 2 I 3 I 4 I 5 I 6 I 7 I 8 I 9 I 10 I sensation imaginable

4. Please use the scale below to tell us how dull your pain feels. Words used to describe very dull pain include "like a dull toothache", "dull pain", and "like a bruise".

Not The most dull dull I 0 I 1 I 2 I 3 I 4 I 5 I 6 I 7 I 8 I 9 I 10 I sensation imaginable

5. Please use the scale below to tell us how cold your pain feels. Words used to describe very cold pain include "like ice" and "freezing".

Not The most cold cold I 0 I 1 I 2 I 3 I 4 I 5 I 6 I 7 I 8 I 9 I10 I sensation imaginable

("freezing")

©GALER & JENSEN, 1997. All rights reserved. Please contact the MAPI Institute (http://www.mapiinstitute.com) to obtain permission to use the Neuropathic Pain Scale.

10-items NPS - US English_

Note: From "Development and preliminary validation of a pain measure specific to neuropathic pain: The Neuropathic Pain Scale," by B. S. Galer and M. P. Jensen, 1997, Neurology, 48, pp. 332-338. Copyright 1997 by Lippincott Williams & Wilkins. Reprinted with permission.

(Continued)

(Continued)

6. Please use the scale below to tell us how sensitive your skin is to light touch or clothing. Words used to describe sensitive skin include "like sunburned skin", and "raw skin".

Not | | | | | | | | | | | | The most sensitive sen- I 0 I 1 I 2 I 3 I 4 I 5 I 6 I 7 I 8 I 9 I 10 I sensation imaginable sitive ("raw skin")

7. Please use the scale below to tell us how itchy your pain feels. Words used to describe itchy pain include "like poison oak" and "like a mosquito bite".

Not The most itchy itchy I 0 I 1 I 2 I 3 I 4 I 5 I 6 I 7 I 8 I 9 I 10 I sensation imaginable

("like poison oak")

8. Which of the following best describes the time quality of your pain? Please check only one answer.

( ) I feel a background pain all of the time and occasional flare-ups (break-through pain) some of the time.

Describe the background pain:_______________________

Describe the flare-up (break-through) pain:__________________

( ) I feel a single type of pain all the time. Describe this pain:________________

( ) I feel a single type of pain only sometimes. Other times, I am pain free.

Describe this occasional pain:_______________________

9. Now that you have told us the different physical aspects of your pain, the different types of sensations, we want you to tell us overall how unpleasant your pain is to you. Words used to describe very unpleasant pain include "miserable" and "intolerable". Remember, pain can have a low intensity, but still feel extremely unpleasant, and some kinds of pain can have a high intensity but be very tolerable. With this scale, please tell us how unpleasant your pain feels.

Not The most unpleasant unpl- I I I I I I I I I I I I sensation imaginable easant ("intolerable")

10. Lastly we want you to give us an estimate of the severity of your deep versus surface pain. We want you to rate each location of pain separately. We realize that it can be difficult to make these estimates, and most likely it will be a "best guess", but please give us your best estimate.

No deep pain

No surface pain

HOW INTENSE IS YOUR DEEP PAIN?

HOW INTENSE IS YOUR SURFACE PAIN?

The most intense deep pain sensation imaginable

The most intense surface pain sensation imaginable

©GALER & JENSEN, 1997. All rights reserved. Please contact the MAPI Institute (http://www.mapiinstitute.com) to obtain permission to use the Neuropathic Pain Scale.

10-items NPS - US English_

Note: From "Development and preliminary validation of a pain measure specific to neuropathic pain: The Neuropathic Pain Scale," by B. S. Galer and M. P. Jensen, 1997, Neurology, 48, pp. 332-338. Copyright 1997 by Lippincott Williams & Wilkins. Reprinted with permission.

Used with permission of the authors.

Disadvantages of the NPS are as follows:

■ Data collected from chronic pain clinic patients that do not reflect the total experience of the larger patient population with neuropathic pain

■ Validation study not randomized; double-blind construct

■ Not all types of neuropathic pain complaints covered in the 11 items of the scale

S-LANSS is a self-administered survey format assessment tool to determine if pain is neuropathic. The main value to the S-LANSS is that it can be used to determine if a patient with chronic pain has a neuropathic element to the pain complaint. It measures similar indicators to the NPS, such as cold sensitivity, pain with pressure, and so forth. The higher the score, the more it indicates a neuropathic type of pain. Advantages of the S-LANSS are as follows:

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