Can the neuropathic pain scale discriminate between non-neuropathic and neuropathic pain?
Can the neuropathic pain scale discriminate between non-neuropathic and neuropathic pain?
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DOI：
10.1111/j.1526-4637.2007.00302.x
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发表时间：
2008-03-01
期刊：
影响因子：
3.1
通讯作者：
Rosomoff, Rennee S.
中科院分区：
文献类型：
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作者：
Fishbain, David A.;Lewis, John E.;Rosomoff, Rennee S.
目标。 1) 确定神经性疼痛量表 (NPS) 是否可用于将慢性疼痛患者 (CPP) 分类为主要神经性疼痛与非神经性疼痛，此外； 2) 确定可以使用什么（如果有）截止分数来可靠地做出此决定。设计。共有 305 名连续入住 Rosomoff 疼痛中心的 CPP 接受了 NPS，并根据体检和所有可用的测试结果进行了诊断。诊断为慢性神经根病和脊椎峡部裂/退行性关节炎的 CPP 被分为两组，目的是让一组代表神经性疼痛（慢性神经根病）和非神经性疼痛（脊椎峡部裂/退行性关节炎）。将神经性疼痛标准应用于“这两组中的每一组”：在慢性神经根病组中确定了神经性疼痛“亚型”；并且，在椎弓峡部裂/退行性关节炎组中发现了一种非神经性疼痛“亚型”。执行此步骤是为了确保选择用于进一步分析的 CPP 真正代表神经性和非神经性疼痛。然后采用判别函数分析来确定 NPS 评分是否可以区分这两种“亚型”。利用判别函数分析模型的结果得出 NPS 截止分数，高于该分数的 CPP 将被归类为患有神经性疼痛。对于肌筋膜疼痛综合征、椎管狭窄、硬膜外纤维化、纤维肌痛、复杂区域疼痛综合征1和2以及背部手术失败综合征的诊断，计算预测的NPS评分并与截止评分进行比较。多学科疼痛设施。患者。慢性疼痛患者。结果。 NPS 似乎能够将 CPP 分为神经性疼痛和非神经性疼痛亚型。该模型得出的截止分数为 5.53。肌筋膜疼痛综合征和椎管狭窄的预测分数分别低于该截止分数，分别为 3.81 和 4.26。硬膜外纤维化、纤维肌痛、复杂区域疼痛综合征 1 和 2 以及背部手术失败综合征的预测得分分别高于截止得分，分别为 6.15、6.35、6.87、9.34 和 7.19。结论。 NPS 似乎能够区分神经性疼痛和非神经性疼痛。目前关于纤维肌痛和复杂区域疼痛综合征 1 等诊断是否可以归类为神经病理性的争论非常激烈。我们的 NPS 截止评分结果表明这些诊断可能具有神经性疼痛成分。我们的 NPS 方法的可靠性和有效性需要在其他神经病理性疼痛模型中进行进一步测试，例如糖尿病周围神经病理性疼痛。
Objectives. 1) To determine if the neuropathic pain scale (NPS) can be used to classify chronic pain patients (CPPs) as having primarily neuropathic vs non-neuropathic pain, and furthermore; 2) to determine what, if any, cut-off score can be used to reliably make this determination.Design. A total of 305 CPPs consecutive admissions to The Rosomoff Pain Center were administered the NPS and were assigned a diagnosis according to the physical examination and all available test results. CPPs with a diagnosis of chronic radiculopathy and spondylolysis/degenerative arthritis were segregated into two groups for the purposes of having a group representative of neuropathic pain (chronic radiculopathy) and non-neuropathic pain (spondylolysis/degenerative arthritis). Applying neuropathic pain criteria to each "of these two groups": a neuropathic pain "subtype" was identified within the chronic radiculopathy group; and, a non-neuropathic pain "subtype" was identified within the spondylolysis/degenerative arthritis group. This step was performed in order to assure that the CPPs selected for further analysis were truly representative of neuropathic and non-neuropathic pain. Discriminant function analysis was then employed to determine if NPS scoring could differentiate between these two "subtypes." Results from the discriminant function analysis model were utilized to derive an NPS cut-off score above which CPPs would be classified as having neuropathic pain. For the diagnoses of myofascial pain syndromes, spinal stenosis, epidural fibrosis, fibromyalgia, complex regional pain syndromes 1 and 2, and failed back surgery syndrome, a predicted NPS score was calculated and compared with the cut-off score.Setting. Multidisciplinary pain facility.Patients. Chronic pain patients.Results. The NPS appeared to be able to separate CPPs into neuropathic pain vs non-neuropathic pain subtypes. The derived cut-off score from the model was 5.53. Myofascial pain syndrome and spinal stenosis had predictive scores lower than this cut-off score at 3.81 and 4.26, respectively. Epidural fibrosis, fibromyalgia, complex regional pain syndromes 1 and 2, and failed back surgery syndrome had predictive scores higher than the cut-off score at 6.15, 6.35, 6.87, 9.34, and 7.19, respectively.Conclusions. The NPS appears to be able to discriminate between neuropathic and non-neuropathic pain. A debate is currently raging as to whether diagnoses, such as fibromyalgia and complex regional pain syndrome 1, can be classified as neuropathic. Our NPS cut-off score results suggest that these diagnoses may have a neuropathic pain component. The reliability and validity of our NPS method will need to be tested further in other neuropathic pain models, such as diabetic peripheral neuropathic pain.