Tailor treatment to the patient with neuropathic pain.

Neuropathic pain can be considered to be a clinical syndrome with multiple causes ranging from damage to peripheral nerve pathways as the level of peripheral nociceptors to abnormalities in the cortical neurons in the brain. It is defined as pain that is caused by a lesion or disease of the somatosensory nervous system and is estimated to affect 6-8% of the general population. A low threshold of suspicion in conditions associates with neuropathic pain can aid diagnosis. Data from the past decade suggest that it is found in 16-26% of patients with diabetes, 8% of patients suffering from shingles in the past three months (increasing to 40% and 75% in patients aged over 50 and 75 respectively), and 10-50% of patients following surgery. Typical neuropathic descriptors include burning, shooting electric shock pain with numbness, pins and needles or itching. After general and neurological examination the focus should turn to the affected pain area using an unaffected body part as a control. Sensory response to cotton wool, pinprick, temperature and vibration should all be assessed. This will identify the positive and negative signs found in neuropathic pain. Tinel's sign and Phalen's sign, although classically taught, have such poor sensitivity and specificity that GPs are no longer encouraged to rely on them, and they should not be used. Neuropathic pain is often poorly responsive to conventional analgesia with the mainstay of treatment being anticonvulsant and antidepressant medication. Multidisciplinary assessment and management in the specialist setting of the pain clinic is often requires.