Neuropathic pain: an updated grading system for research and clinical practice.
Neuropathic pain: an updated grading system for research and clinical practice.
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DOI：
10.1097/j.pain.0000000000000492
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发表时间：
2016-08
期刊：
影响因子：
7.4
通讯作者：
Jensen TS
中科院分区：
文献类型：
--
作者：
Finnerup NB;Haroutounian S;Kamerman P;Baron R;Bennett DLH;Bouhassira D;Cruccu G;Freeman R;Hansson P;Nurmikko T;Raja SN;Rice ASC;Serra J;Smith BH;Treede RD;Jensen TS
国际疼痛研究协会（IASP）神经性疼痛特别研究小组（NeuPSIG）于2008年提出，将神经性疼痛重新定义为“由影响体感觉系统的病变或疾病直接引起的疼痛”，这一定义已被广泛接受。相比之下，2008年提出的可能的、可能的和确定的神经性疼痛分级系统在较小程度上被使用。在这里，我们报告了对2008年原始NeuPSIG评分文件的引用分析，随后是专家小组对其使用情况的分析以及对改进评分系统的建议。截至2015年2月，Scopus中有608篇符合条件的文章引用了该论文，其中414篇引用了神经性疼痛的定义。在引用这篇论文的220项临床研究中，有56项使用了评分系统。使用评分系统的比例从2009年的5%上升到2014年的30%。确定了更广泛使用分级系统的障碍，包括(1)关于确认性测试的相对重要性的问题，(2)筛选工具的作用，以及(3)关于神经解剖学上合理的疼痛分布的不确定性。在这里，我们提出了一个经过修订的分级系统，调整了顺序，更好地反映了临床实践，改进了规范，并警告说，即使是“明确”的神经性疼痛水平也并不总是表明因果关系。此外，我们还增加了一个表，说明了常见神经性疼痛条件下的疼痛和感觉异常区域，并提出了进一步研究的领域。
The redefinition of neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system,” which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the “definite” level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research.