Towards a definition of refractory neuropathic pain for epidemiological research

an international Delphi survey of experts

Blair H. Smith (Lead / Corresponding author), Nicola Torrance, Janice A. Ferguson, Michael I. Bennett, Michael G. Serpell, Kate M. Dunn

    Research output: Contribution to journalArticle

    22 Citations (Scopus)

    Abstract

    BACKGROUND: Best current estimates of neuropathic pain (NeuP) prevalence come from studies using various screening detecting pain with probable neuropathic features; the proportion experiencing significant, long-term NeuP, and the proportion not responding to standard treatment are unknown. These "refractory" cases are the most clinically important to detect, being the most severe, requiring specialist treatment.

    METHODS: We report an international Delphi survey of experts in NeuP, aiming for consensus on the features required to define, for epidemiological research: (1) neuropathic pain; and (2) when NeuP is "refractory". A web-based questionnaire was developed and data collected from three rounds of questionnaires from nineteen experts.

    RESULTS: There was good consensus on essential inclusion of six items to identify NeuP ("prickling, tingling, pins & needles", "pain evoked by light touch", "electric shocks or shooting pain", "hot or burning" pain, "brush allodynia on self-examination", and "relevant history") and on some items that were non-essential. Consensus was also reached on components of a "refractory NeuP" definition: minimum duration (one year); number of trials of drugs of known effectiveness (four); adequate duration of these trials (three months / maximum tolerated); outcomes of treatment (pain severity, quality of life). Further work needs to validate these proposed criteria in general population research.

    CONCLUSIONS: This paper presents an international consensus on measuring the epidemiology of refractory neuropathic pain. This will be valuable in reaching an agreed estimate of the prevalence of neuropathic pain, and the first estimate of refractory neuropathic pain prevalence.

    Original languageEnglish
    Article number29
    JournalBMC Neurology
    Volume12
    DOIs
    Publication statusPublished - 28 May 2012

    Fingerprint

    Intractable Pain
    Neuralgia
    Research
    Consensus
    Pain
    Surveys and Questionnaires
    Self-Examination
    Hyperalgesia
    Touch
    Needles
    Shock
    Epidemiology
    Cross-Sectional Studies
    History
    Quality of Life

    Keywords

    • Neuropathic pain
    • Refractory
    • Epidemiology
    • Delphi method
    • Web-based questionnaire

    Cite this

    Smith, Blair H. ; Torrance, Nicola ; Ferguson, Janice A. ; Bennett, Michael I. ; Serpell, Michael G. ; Dunn, Kate M. / Towards a definition of refractory neuropathic pain for epidemiological research : an international Delphi survey of experts. In: BMC Neurology. 2012 ; Vol. 12.
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    title = "Towards a definition of refractory neuropathic pain for epidemiological research: an international Delphi survey of experts",
    abstract = "BACKGROUND: Best current estimates of neuropathic pain (NeuP) prevalence come from studies using various screening detecting pain with probable neuropathic features; the proportion experiencing significant, long-term NeuP, and the proportion not responding to standard treatment are unknown. These {"}refractory{"} cases are the most clinically important to detect, being the most severe, requiring specialist treatment.METHODS: We report an international Delphi survey of experts in NeuP, aiming for consensus on the features required to define, for epidemiological research: (1) neuropathic pain; and (2) when NeuP is {"}refractory{"}. A web-based questionnaire was developed and data collected from three rounds of questionnaires from nineteen experts.RESULTS: There was good consensus on essential inclusion of six items to identify NeuP ({"}prickling, tingling, pins & needles{"}, {"}pain evoked by light touch{"}, {"}electric shocks or shooting pain{"}, {"}hot or burning{"} pain, {"}brush allodynia on self-examination{"}, and {"}relevant history{"}) and on some items that were non-essential. Consensus was also reached on components of a {"}refractory NeuP{"} definition: minimum duration (one year); number of trials of drugs of known effectiveness (four); adequate duration of these trials (three months / maximum tolerated); outcomes of treatment (pain severity, quality of life). Further work needs to validate these proposed criteria in general population research.CONCLUSIONS: This paper presents an international consensus on measuring the epidemiology of refractory neuropathic pain. This will be valuable in reaching an agreed estimate of the prevalence of neuropathic pain, and the first estimate of refractory neuropathic pain prevalence.",
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    Towards a definition of refractory neuropathic pain for epidemiological research : an international Delphi survey of experts. / Smith, Blair H. (Lead / Corresponding author); Torrance, Nicola; Ferguson, Janice A.; Bennett, Michael I.; Serpell, Michael G.; Dunn, Kate M.

    In: BMC Neurology, Vol. 12, 29, 28.05.2012.

    Research output: Contribution to journalArticle

    TY - JOUR

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    AU - Smith, Blair H.

    AU - Torrance, Nicola

    AU - Ferguson, Janice A.

    AU - Bennett, Michael I.

    AU - Serpell, Michael G.

    AU - Dunn, Kate M.

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    N2 - BACKGROUND: Best current estimates of neuropathic pain (NeuP) prevalence come from studies using various screening detecting pain with probable neuropathic features; the proportion experiencing significant, long-term NeuP, and the proportion not responding to standard treatment are unknown. These "refractory" cases are the most clinically important to detect, being the most severe, requiring specialist treatment.METHODS: We report an international Delphi survey of experts in NeuP, aiming for consensus on the features required to define, for epidemiological research: (1) neuropathic pain; and (2) when NeuP is "refractory". A web-based questionnaire was developed and data collected from three rounds of questionnaires from nineteen experts.RESULTS: There was good consensus on essential inclusion of six items to identify NeuP ("prickling, tingling, pins & needles", "pain evoked by light touch", "electric shocks or shooting pain", "hot or burning" pain, "brush allodynia on self-examination", and "relevant history") and on some items that were non-essential. Consensus was also reached on components of a "refractory NeuP" definition: minimum duration (one year); number of trials of drugs of known effectiveness (four); adequate duration of these trials (three months / maximum tolerated); outcomes of treatment (pain severity, quality of life). Further work needs to validate these proposed criteria in general population research.CONCLUSIONS: This paper presents an international consensus on measuring the epidemiology of refractory neuropathic pain. This will be valuable in reaching an agreed estimate of the prevalence of neuropathic pain, and the first estimate of refractory neuropathic pain prevalence.

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