Neuropathic Pain: Enhancing Assessment and Management Skills

Overview

Series Introduction

Between 18 and 30 million Americans report chronic pain with neuropathic characteristics.^1-3 In primary care, 60 to 80 of every 1,000 patients present with symptoms of chronic neuropathic pain.⁴ Despite these high numbers, neuropathic pain continues to present diagnostic and management challenges.

Neuropathic pain is difficult to differentiate from other chronic pain conditions, in part because patients often have trouble describing the unique characteristics of neuropathic pain, making recognition and diagnosis challenging.^5,6 Furthermore, neuropathic pain is more difficult and complicated to treat than other types of chronic pain.^7-9 Finding an effective regimen requires a trial-and-error approach that at times can be frustrating to both physician and patient.⁷

This two-part AAFP LearningLink series demonstrates practical, evidence-based strategies for assessment, diagnosis, and management of neuropathic pain using faculty discussions and case studies to reinforce learning points. Downloadable resources offer easy access to evidence-based recommendations, references, and practice tools.

References

1. Torrance N, et al. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population study. J Pain 2006;7:281–9.
2. Bouhassira D, et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008;136:380–7.
3. Yawn B, et al. The prevalence of neuropathic pain: Clinical evaluation compared with screening tools in a community population. Pain Med 2009;10:586–93.
4. McDermott AM, et al. The burden of neuropathic pain: Results of a cross-selective survey. Eur J Pain 2006;10:127–35.
5. Galer BS, et. Painful diabetic polyneuropathy: Epidemiology, pain description, and quality of life. Diabetes Res Clin Pract 2000;47:123–8.
6. Smith EL, et al. The total neuropathy score (TNS): A tool for measuring chemotherapy-induced peripheral neuropathy. Oncol Nurs Forum 2008;35:96–102.
7. Dworkin RH, et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain 2007;132:237-51.
8. Portenoy RK, et al. The nature of opioid responsiveness and its implications for neuropathic pain: New hypotheses derived from studies of opioid infusions. Pain 1990;43:273-86.
9. Gilron I, Max MB. Combination pharmacotherapy for neuropathic pain: Current evidence and future directions. Expert Rev Neurother 2005;5:823–30.

Series Objectives

After completing this two-part series, the learner will be able to:

• Apply evidence-based recommendations for assessment and management of neuropathic pain in clinical practice.
• Recognize signs and symptoms of neuropathic pain to facilitate timely diagnosis and management.
• Differentiate among commonly encountered neuropathic pain conditions and their various causes in order to select appropriate treatments.
• Improve assessment of neuropathic pain in clinical practice, including assessment of comorbidities.
• Apply evidence-based strategies in the selection and use of first-, second- and third-line pharmacotherapy for common neuropathic pain syndromes.
• Develop tailored treatment plans that address common and potentially debilitating comorbidities, such as depression and sleep disturbances.
• Implement practical approaches to monitoring treatment response, managing adverse effects and optimizing outcomes.

Acknowledgment of Support

These activities are supported by an independent educational grant from Pfizer and PriCara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC.

Accessing the CME Activities

LearningLink is hosted by AAFP's technology partner MedEdArchitects. To access the activities (and to allow us to track learner progress through the program), you will need a LearningLink account. The only information required is your name, email address, and member status. Create a LearningLink account(www.aafplearninglink.org).

Learning Activities