BackCare

Test for diagnosing neuropathic pain

08 Apr 2009

New research improves diagnosing neuropathic pain.

A study by researchers at Massachusetts General and Addenbrookes Hospitals published in PLoS Medicine on 7 April 2009 and reported by media organisations including the BBC, claims to have developed a new “bedside” method to accurately identify pain caused by nerve damage (neuropathic pain). This pain is very different to pain caused by other factors and is described as a sharp, shooting or burning pain.

It is often difficult to diagnose and therefore difficult to treat with wrong diagnoses usually leading to unsuccessful treatment. Difficulty in treatment is also compounded by the fact that the nerve injury that causes the pain in these cases may no longer be present but the pain messages to the brain continue. Traditional pain killers often have little effect on neuropathic pain and other treatment options such as anti-depressants and exercise also have limited effects.

The new diagnostic system, known as the Standardised Evaluation of Pain (StEP) method consists of a questionnaire of sixteen questions and ten simple physical tests which can be completed in 10-15 minutes. The method was developed with the help of over 300 patients who suffered from neuropathic pain, many of whom suffered from both neuropathic and non-neuropathic back pain. Researchers aimed to find commonalities in the responses of those suffering from neuropathic pain. The results showed that the StEP method was extremely effective in differentiating between those with neuropathic pain and those with pain of a different origin. The StEP method appeared to be superior to standard neuropathic pain screening tools and spinal Magnetic Resonance Imaging (MRI). While more research may be needed before this new tool can be used on a larger scale, the implications of these findings are far reaching and could improve the treatment of neuropathic pain.

Commenting on these finding for the BBC BackCare’s  then Head of Research and Policy, Dr Dries Hettinga said: "People with neuropathic back pain need a different treatment approach than those with non-neuropathic pain and an accurate and easy to use tool to distinguish the two types of pain would not only benefit people with back pain, but also help to tailor treatments for people with back pain and thus decrease costs."

The original study can be found in PLoS. See also the comment on the NHS Choices website.