Assessment of neuropathic pain in primary care

Maija L. Haanpaa, Misha-Miroslav Backonja, Michael I. Bennett, Didier Bouhassira, Giorgio Cruccu, Per T. Hansson, Troels Staehelin Jensen, Timo Kauppila, Andrew S. C. Rice, Blair H. Smith, Rolf-Detlef Treede, Ralf Baron

    Research output: Contribution to journalArticlepeer-review

    170 Citations (Scopus)


    Management of patients presenting with chronic pain is a common problem in primary care. Essentially, the classification of chronic pain falls into 3 broad categories: (1) pain owing to tissue disease or damage (nociceptive pain), (2) pain caused by somatosensory system disease or damage (neuropathic pain), and (3) pain without a known somatic background. Key challenges in developing a targeted holistic approach to treatment include appropriate diagnosis of the cause or causes of pain; identifying the type of pain and assessing the relative importance of its various components; and determining appropriate treatment. In clinical examination, sensory abnormalities are the crucial findings leading to a diagnosis of neuropathic pain, for which pharmacotherapy with antidepressants and anticonvulsants represents the cornerstone of medical treatment. Chronic neuropathic pain is underrecognized and undertreated, yet primary care physicians are uniquely placed on the frontlines of patient management, where they can play a pivotal role in treatment and prevention through diagnosis, therapy, follow-up, and referral. This review provides guidance in understanding and identifying the neuropathic contribution to pain presenting in primary care; assessing its severity through patient history, physical examination, and appropriate diagnostic tests; and establishing a rational treatment plan. (C) 2009 Elsevier Inc. All rights reserved. The American Journal of Medicine (2009) 122, S13-S21

    Original languageEnglish
    Pages (from-to)S13-S21
    Number of pages9
    JournalAmerican Journal of Medicine
    Issue number10
    Publication statusPublished - Oct 2009


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