Incontro Nazionale Neurofisiologia: Nuove Strategie
14
Gli Strumenti di Screening devono essere applicati nella diagnosi di DN? Si Nadine Attal No Sandrini Discussant Brigida Fierro, Angelo Quartarone Incontro Nazionale Neurofisiologia: Nuove Strategie “Controversie sulla diagnosi e terapia del dolore neuropatico” Palermo, 29-30 novembre 2012
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Incontro Nazionale Neurofisiologia: Nuove Strategie “ Controversie sulla diagnosi e terapia del dolore neuropatico ” Palermo, 29-30 novembre 2012. - PowerPoint PPT Presentation
Transcript of Incontro Nazionale Neurofisiologia: Nuove Strategie
Gli Strumenti di Screening devono essereapplicati nella diagnosi di DN
Si Nadine AttalNo Sandrini
DiscussantBrigida Fierro Angelo Quartarone
Incontro Nazionale Neurofisiologia Nuove Strategie
ldquoControversie sulla diagnosi e terapia del dolore neuropaticordquo
Palermo 29-30 novembre 2012
Premesse Il TopicBrigida Fierro
Dipartimento BioNec Universitagrave degli studi di Palermo
Palermo 29-30 novembre 2012
Neuropathic Pain definition
Neurology 2008 Apr 2970(18)1630-5 Epub 2007 Nov 14Neuropathic pain redefinition and a grading system for clinical and research purposesTreede RD Jensen TS Campbell JN Cruccu G Dostrovsky JO Griffin JW Hansson P Hughes R Nurmikko T Serra J
The International Association for the Study of Pain (IASP 1994) introduced the term neuropathic pain defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain it lacks defined boundaries
The Neurophatic pain Special interest group (NeuPSIG 2008) present a more precise definition pain arising as a direct consequence of a lesion or disease affecting the somatosensory system
so including a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain
Palermo 29-30 novembre 2012
Palermo 29-30 novembre 2012
The challenge is
to differentiate neuropathic pain from other types of pain
and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Methods of assessing nerve function
(1) bedside examination which relies on the physicians experience and the patients ability and willingness to collaborate (2) quantitative sensory testing a measure that despite using quantitative graded stimuli also relies on the patients evaluation (3) laboratory tests use quantitative tools and measure an objective responses
The challenge is first step to differentiate neuropathic pain from other
types of pain and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Grading system of neuropathic pain (NeuPSIG 2008)
Palermo 29-30 novembre 2012Treede et al Neurology 2008
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
Premesse Il TopicBrigida Fierro
Dipartimento BioNec Universitagrave degli studi di Palermo
Palermo 29-30 novembre 2012
Neuropathic Pain definition
Neurology 2008 Apr 2970(18)1630-5 Epub 2007 Nov 14Neuropathic pain redefinition and a grading system for clinical and research purposesTreede RD Jensen TS Campbell JN Cruccu G Dostrovsky JO Griffin JW Hansson P Hughes R Nurmikko T Serra J
The International Association for the Study of Pain (IASP 1994) introduced the term neuropathic pain defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain it lacks defined boundaries
The Neurophatic pain Special interest group (NeuPSIG 2008) present a more precise definition pain arising as a direct consequence of a lesion or disease affecting the somatosensory system
so including a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain
Palermo 29-30 novembre 2012
Palermo 29-30 novembre 2012
The challenge is
to differentiate neuropathic pain from other types of pain
and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Methods of assessing nerve function
(1) bedside examination which relies on the physicians experience and the patients ability and willingness to collaborate (2) quantitative sensory testing a measure that despite using quantitative graded stimuli also relies on the patients evaluation (3) laboratory tests use quantitative tools and measure an objective responses
The challenge is first step to differentiate neuropathic pain from other
types of pain and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Grading system of neuropathic pain (NeuPSIG 2008)
Palermo 29-30 novembre 2012Treede et al Neurology 2008
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
Neuropathic Pain definition
Neurology 2008 Apr 2970(18)1630-5 Epub 2007 Nov 14Neuropathic pain redefinition and a grading system for clinical and research purposesTreede RD Jensen TS Campbell JN Cruccu G Dostrovsky JO Griffin JW Hansson P Hughes R Nurmikko T Serra J
The International Association for the Study of Pain (IASP 1994) introduced the term neuropathic pain defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain it lacks defined boundaries
The Neurophatic pain Special interest group (NeuPSIG 2008) present a more precise definition pain arising as a direct consequence of a lesion or disease affecting the somatosensory system
so including a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain
Palermo 29-30 novembre 2012
Palermo 29-30 novembre 2012
The challenge is
to differentiate neuropathic pain from other types of pain
and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Methods of assessing nerve function
(1) bedside examination which relies on the physicians experience and the patients ability and willingness to collaborate (2) quantitative sensory testing a measure that despite using quantitative graded stimuli also relies on the patients evaluation (3) laboratory tests use quantitative tools and measure an objective responses
The challenge is first step to differentiate neuropathic pain from other
types of pain and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Grading system of neuropathic pain (NeuPSIG 2008)
Palermo 29-30 novembre 2012Treede et al Neurology 2008
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
Palermo 29-30 novembre 2012
The challenge is
to differentiate neuropathic pain from other types of pain
and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Methods of assessing nerve function
(1) bedside examination which relies on the physicians experience and the patients ability and willingness to collaborate (2) quantitative sensory testing a measure that despite using quantitative graded stimuli also relies on the patients evaluation (3) laboratory tests use quantitative tools and measure an objective responses
The challenge is first step to differentiate neuropathic pain from other
types of pain and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Grading system of neuropathic pain (NeuPSIG 2008)
Palermo 29-30 novembre 2012Treede et al Neurology 2008
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
The challenge is
to differentiate neuropathic pain from other types of pain
and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Methods of assessing nerve function
(1) bedside examination which relies on the physicians experience and the patients ability and willingness to collaborate (2) quantitative sensory testing a measure that despite using quantitative graded stimuli also relies on the patients evaluation (3) laboratory tests use quantitative tools and measure an objective responses
The challenge is first step to differentiate neuropathic pain from other
types of pain and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Grading system of neuropathic pain (NeuPSIG 2008)
Palermo 29-30 novembre 2012Treede et al Neurology 2008
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
Methods of assessing nerve function
(1) bedside examination which relies on the physicians experience and the patients ability and willingness to collaborate (2) quantitative sensory testing a measure that despite using quantitative graded stimuli also relies on the patients evaluation (3) laboratory tests use quantitative tools and measure an objective responses
The challenge is first step to differentiate neuropathic pain from other
types of pain and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Grading system of neuropathic pain (NeuPSIG 2008)
Palermo 29-30 novembre 2012Treede et al Neurology 2008
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
The challenge is first step to differentiate neuropathic pain from other
types of pain and then to diagnose the lesion or disease causing the
pain
Palermo 29-30 novembre 2012
Neuropathic Pain
Grading system of neuropathic pain (NeuPSIG 2008)
Palermo 29-30 novembre 2012Treede et al Neurology 2008
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
Grading system of neuropathic pain (NeuPSIG 2008)
Palermo 29-30 novembre 2012Treede et al Neurology 2008
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Pain is a subjective condition that cannot be objectively measured for this reason self patient-perspective is crucial to evaluate
character (quality intensitytemporal aspects stimulus-dependent or not etc)
distribution of pain (confined to innervation territory of the affected nervous structure)
Presence of positive or negative symptoms or signs
Neuropathic vs nociceptive Pain
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
recently several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain
Screening toolsScreening tools
Based on pain descriptors
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
Modern Screening tools
Palermo 29-30 novembre 2012
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
se il punteggio del paziente egrave uguale o maggiore di 410 il test egrave positivo (sensibilitagrave=829 specificitagrave=899)
Bouhassira et 2005 versione italiana a cura di Caraceni Zecca e Martini)
Le Douleur Neuropathique 4 DN4 Italian VersionLe Douleur Neuropathique 4 DN4 Italian Version
PhysicianExamination
PhysicianExamination
Interview Subjective measures
Interview Subjective measures
bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
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bull identify patients with possible neuropathic pain
bull are easy to use bull provide immediately
available informations bull are useful for research
pourposes
Pearls Pitfalls
Screening toolsScreening tools
bull fail to identify abot 10-20 of patients with clinical diagnosed neuropahic pain
sobull cannot replace clinical
judgment
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
-
Screening Tools
The questions are
are they useful in the real life or only for clinical trials
do they identify subtypes of neuropathic pain
can they be used to assess the effects of treatment
should also be used to predict treatment outcome and better define responder profiles to treatment
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
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