Neuropathic pain presents the family physician with numerous challenges in terms of diagnosis and management. The condition is hard to differentiate from other chronic pain conditions, yet many physicians may be unaware of the existence of screening tools that can assist them in identifying neuropathic pain.1,2 In a survey of AAFP LearningLink participants, 55 percent of respondents said they did not use neuropathic pain screening tools on a regular basis. In fact, 37 percent of respondents were not aware that these tools existed.3
Neuropathic pain is more difficult to treat than other types of chronic pain.4 Patients exhibit a more variable response to analgesics,5 and the different pain mechanisms involved in the condition mean that combination therapy is frequently required.6 Comorbid conditions such as sleep deprivation, anxiety and depression also affect response to treatment. Ultimately, many patients require multidisciplinary strategies to achieve adequate pain relief and return to normal functioning.4,7,8
In this first activity, Principles of Neuropathic Pain Assessment and Management, the faculty describes a practical approach to the diagnosis and assessment of neuropathic pain, including the role of neuropathic pain screening tools. They discuss pharmacologic and nonpharmacologic management approaches, as well as outlining evidence-based treatment algorithms for the most common neuropathic pain syndromes. Finally, faculty members provide strategies for identifying and addressing common comorbidities.
Activity 1: Principles of Neuropathic Pain Assessment and Management
- Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract 2000;47:123-8.
- Smith EL, Beck SL, Cohen J. The total neuropathy score (TNS): a tool for measuring chemotherapy-induced peripheral neuropathy. Oncol Nurs Forum 2008;35:96-102.
- Data on file. AAFP Neuropathic Pain Baseline Assessment. January 2011.
- Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132(3):237-51.
- Portenoy RK, Foley KM, Inturrisi CE. The nature of opioid responsiveness and its implications for neuropathic pain: new hypotheses derived from studies of opioid infusions. Pain 1990;43(3):273-86.
- Gilron I, Max MB. Combination pharmacotherapy for neuropathic pain: Current evidence and future directions. Expert Rev Neurother 2005;5:823-30.
- Hall CG, Carroll D, Parry D, McQuay HJ. Epidemiology and treatment of neuropathic pain: the UK primary care perspective. Pain 2006;122:156-62.
- Chen H, Lamer TJ, Rho RH, Marshall KA, Sitzman BT, Ghazi SM, et al. Contemporary management of neuropathic pain for the primary care physician. Mayo Clin Proc 2004;79(12):1533-45.
Learning Objectives
After completing this activity, family physicians will be better 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 patients with 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.
Accessing the Activity
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.
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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.
