Identification of neuropathic pain in patients with neck/upper limb pain: Application of a grading system and screening tools

Abstract Background and aims In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic pain (NeP). We previously applied this classification system, along with two NeP screening tools, the painDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS), to identify NeP in patients with neck/upper limb pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q. Methods In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians’ clinical classification was used as “gold standard” to determine the diagnostic accuracy of the two NeP screening tools. Results The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716–850; κ 0.62, 95% CI 0.50–0.73), yielding a 77% agreement. Compared to the clinicians’ consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%). Conclusions The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/upper limb pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/upper limb pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/upper limb pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice. Implications Our observations suggest that in view of the heterogeneity in patients with neck/upper limb pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/upper limb pain remains questionable.

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Cervical Spinal Cord and Dorsal Nerve Root Stimulation for Neuropathic Upper Limb Pain

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.294 ◽

2016 ◽

Vol 44 (1) ◽

pp. 83-89 ◽

Cited By ~ 7

Author(s):

Adrian B. Levine ◽

Andrew G. Parrent ◽

Keith W. MacDougall

Keyword(s):

Neuropathic Pain ◽

Upper Limb ◽

Analogue Scale ◽

Visual Analogue Scale Pain ◽

Limb Pain ◽

Chronic Neuropathic Pain ◽

Analogue Scale Pain ◽

Dorsal Nerve ◽

Upper Limb Pain ◽

Root Stimulation

AbstractBackground: Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain in the lower limbs. Upper limb pain comprises a significant proportion of neuropathic pain patients, but is often difficult to target specifically and consistently with paresthesias. We hypothesized that the use of dorsal nerve root stimulation (DNRS), as an option along with SCS, would help us better relieve pain in these patients. Methods: All 35 patients trialed with spinal stimulation for upper limb pain between July 1, 2011, and October 31, 2013, were included. We performed permanent implantation in 23/35 patients based on a visual analogue scale pain score decrease of ≥50% during trial stimulation. Results: Both the SCS and DNRS groups had significant improvements in average visual analogue scale pain scores at 12 months compared with baseline, and the majority of patients in both groups obtained ≥50% pain relief. The majority of patients in both groups were able to reduce their opioid use, and on average had improvements in Short Form-36 quality of life scores. Complication rates did not differ significantly between the two groups. Conclusions: Treatment with SCS or DNRS provides meaningful long-term relief of chronic neuropathic pain in the upper limbs.

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Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

Journal of International Medical Research ◽

10.1177/03000605211004035 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052110040

Author(s):

Kuen Su Lee ◽

Yoo Kyung Jang ◽

Gene Hyun Park ◽

In Jae Jun ◽

Jae Chul Koh

Keyword(s):

Spinal Cord ◽

Upper Limb ◽

Spinal Cord Stimulation ◽

Therapeutic Potential ◽

Case Series ◽

Limb Amputation ◽

Intractable Pain ◽

Limb Pain ◽

Cord Injury ◽

Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

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Common challenges in managing neck and upper limb pain in office workers

10.31128/ajgp-07-19-4986 ◽

2019 ◽

Vol 48 (11) ◽

pp. 746-750

Author(s):

Brendan Mouatt ◽

Steven J Kamper

Keyword(s):

Upper Limb ◽

Office Workers ◽

Limb Pain ◽

Upper Limb Pain

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Superior vena cava obstruction with thrombolytic therapy in primary antiphospholipid syndrome

10.22541/au.161203349.96268572/v1 ◽

2021 ◽

Author(s):

Manal Adel ◽

Marwa Mashaal ◽

Kareem Mahmoud ◽

Shady Mashhour ◽

Haytham Soliman

Keyword(s):

Thrombolytic Therapy ◽

Superior Vena Cava ◽

Antiphospholipid Syndrome ◽

Upper Limb ◽

Superior Vena ◽

Vena Cava ◽

Primary Antiphospholipid Syndrome ◽

Superior Vena Cava Obstruction ◽

Limb Pain ◽

Upper Limb Pain

We report a case of superior vena cava obstruction of a 39 years old female patient with primary antiphospholipid syndrome presented with upper limb pain and swelling ,which improved on thrombolytic therapy ,we review patients with Antiphospholipid syndrome and management with thrombolytic therapy .

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