Sunday, 28 January 2018

What Do We Really Know About Neuropathic Pain? (Vid)

Today's post from (see link below) doesn't make for easy listening but if you have 30 minutes to spare and want to know how medical scientists talk to each other about the disease that impacts our lives so greatly, it's well worth your time. It's not so difficult as to be incomprehensible (like so many of this type of lecture) but may require a bit of concentration to get through. I guarantee you'll learn quite a bit more about neuropathy and as such, will benefit from wider knowledge. Part of the difficulty with neuropathy is its inconsistency - no one patient responds the same as another, so we have to look for things that are common to us all and that means looking a little deeper into the science of it all. The fact that medical professionals have so many problems with neuropathy treatment should give us some comfort - if they find it baffling at times and struggle to find efficient treatments for the symptoms, means that our confusion is perfectly normal. See what you think. (Epidemiology, by the way, is imply put, the study of what befalls a population.)
Epidemiology of Neuropathic Pain: What do we really know? 
Blair Smith 
Time Required:
30 minutes


Blair Smith is Professor of Primary Care Medicine; Head of Section, General Practice and Community Medical Education; Deputy Head, Centre of Academic Primary Care; General Practitioner, Peterhead Health Centre and Honorary Consultant in Primary Care (NHS Grampian). His Research Interests include genetic epidemiology (including Generation Scotland); chronic pain (including neuropathic pain); primary care epidemiology; medical education; literature and medicine. He is also the Programme Director (Biological Mechanisms) of the Aberdeen Pain Research Collaboration.

Blair summarises what we know about neuropathic pain and the problems encountered with epidemiological research with regards to:

The estimated prevalence
Prevalence of neuropathic pain associated with some conditions
Proportion of those with some of these conditions who have neuropathic pain.
Prevalence of the population responding positively to some of the screening instruments
Factors associated with these (risk and impact)
How to move from this baseline to hold more valuable information.

‘Epidemiology of Neuropathic Pain’

Epidemiology is an important clinical tool in designing and evaluating management and prevention strategies. Its aims - to identify incidence, prevalence, distribution and determinants - are particularly relevant to neuropathic pain. However, there is a relative lack of accurate information available. This is for several good reasons, including lack of a gold standard case definition, or means of applying any agreed definition in population-based research. In one sense, neuropathic pain describes a symptom or a mechanism, rather than a specific disease. On the other hand, there are sufficient similarities in the effects and response to treatment between different causes of neuropathic pain to make it worthwhile considering it as a distinct condition.

Estimates of prevalence that are based on specific causes of neuropathic pain tend to be lower (1% to 2%) [1], [2] than those that are based on reports of the classic symptoms (6% to 8%) [3], [4]. While the former is probably an under-estimate, [5] the latter may be an over-estimate, and further methodological research is still needed. Neuropathic pain of any cause is associated with poor general health, probably more so than non-neuropathic pain of equivalent severity, [6] and is comparable to other severe chronic diseases in this regard. Psychosocial risk factors for neuropathic pain are similar to those for other chronic pain; there are, however, important mechanism-based risk factors that need to be considered, with a view to preventing specific causes of neuropathic pain, including painful diabetic neuropathy and postsurgical pain. The importance of newly proposed risk factors, including genetic factors, is still to be assessed at a population level.


Bowsher, D., 1991. Neurogenic pain syndromes and their management.. British medical bulletin, British medical bulletin 47, 644-66.

Bennett, G.J., 1997. Neuropathic pain: an overview., in: Borsook, D., Molecular Biology Of Pain. , Molecular Biology Of Pain. . IASP Press, Seattle, WA.

Torrance, N., Smith, B.H., Bennett, M.I., Lee, A.J., 2006. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey.. The journal of pain : official journal of the American Pain Society, The journal of pain : official journal of the American Pain Society 7, 281-9.

Bouhassira, D., Lantéri-Minet, M., Attal, N., Laurent, B., Touboul, C., 2008. Prevalence of chronic pain with neuropathic characteristics in the general population.. Pain, Pain 136, 380-7.

Dworkin, R.H., 2002. An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms.. The Clinical journal of pain, The Clinical journal of pain 18, 343-9.

Smith, B.H., Torrance, N., Bennett, M.I., Lee, A.J., 2007. Health and quality of life associated with chronic pain of predominantly neuropathic origin in the community.. The Clinical journal of pain, The Clinical journal of pain 23, 143-9.

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