The Epidemiology of Chronic Pain of Predominantly Neuropathic Origin. Results From a General Population Survey

Department of General Practice and Primary Care, University of Aberdeen, Scotland.
Journal of Pain (Impact Factor: 4.01). 05/2006; 7(4):281-9. DOI: 10.1016/j.jpain.2005.11.008
Source: PubMed


Progress in the understanding of chronic pain with neuropathic features has been hindered by a lack of epidemiologic research in the general population. The Leeds Assessment of Neuropathic Symptoms and Signs score (S-LANSS) was recently validated for use in postal surveys, making the identification of pain of predominantly neuropathic origin possible. Six family practices in 3 UK cities (Aberdeen, Leeds, and London) generated a total random sample of 6,000 adults. The mailed questionnaire included demographic items, chronic pain identification, and intensity questions, the S-LANSS, the Level of Expressed Needs questionnaire, and the Neuropathic Pain Scale. With a corrected response rate of 52%, the prevalence of any chronic pain was 48% and the prevalence of pain of predominantly neuropathic origin was 8%. Respondents with this chronic neuropathic pain were significantly more likely to be female, slightly older, no longer married, living in council rented accommodation, unable to work, have no educational qualifications, and be smokers than all other respondents. Multiple logistic regression modeling found that pain of predominantly neuropathic origin was independently associated with older age, gender, employment (being unable to work), and lower educational attainment. Respondents with this pain type also reported significantly greater pain intensity, higher scores on the NPS, higher levels of expressed need, and longer duration of pain. This is the first estimate of the prevalence and distribution of pain of predominantly neuropathic origin in the general population, using a previously validated and reliable data collection instrument. PERSPECTIVE: Chronic pain with neuropathic features appears to be more common in the general population than previously suggested. This type of pain is more severe than other chronic pain but distributed similarly throughout sociodemographic groups.

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Available from: Blair H Smith, Jun 16, 2014
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    • "They usually present as paroxysmal pain, focal tenderness and cold intolerance. Neuropathic pain results from damage or disease affecting the somatosensory system [20] . It may be associated with abnormal sensations called dysesthesias, and pain produced by normally non-painful stimuli (allodynia). "

    Full-text · Article · Jan 2016
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    • "Neuropathic pain is a chronic and disabling pain condition which incidence involves up to 7–8% of the general population (Hall et al., 2006;Torrance et al., 2006;Bouhassira et al., 2008;Dieleman et al., 2008). Neuropathic pain includes central pain (Schwartzman et al., 2001;Nicholson, 2004) which concerns up to 10–30% of spinal cord injuries (Schwartzman et al., 2001;Nicholson, 2004) and 1.5–8% of strokes (Andersen et al., 1995;Demasles et al., 2008;Klit et al., 2009). "
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    ABSTRACT: Background: Repetitive transcranial magnetic stimulation (rTMS) appears as a useful tool to alleviate neuropathic pain but only few data are available for the long-term benefit of this treatment. Methods: Here we report the effects of rTMS sessions, considered as a possible therapy for pain relief after a failure of different medications in patients with central (neuropathic) pain. We review here the prospectively collected data of the first forty patients treated as follow: 20 Hz stimulation delivered over the contralateral primary motor cortex (M1), each 3-4 weeks. Results: A total of 440 rTMS sessions was collected (mean sessions number: 11, range: 1-37, follow-up 312 days on average, maximum 2.8 years). After four sessions, nine patients (22.5%) discontinued rTMS because of a lack of efficiency (<10% pain-relief). The other 31 patients (77.5%) had a cumulative effect across sessions leading to a mean pain relief of 41% for a duration of 15.6 days. A correlation was observed between pain relief in the first session and long-term pain relief (R = 0.649. p = 5.6*10(-6) ). Both intensity and duration of pain relief were significantly better for patients with persistent laser evoked potentials (LEPs, p = 0.049 and 0.0018). We did not observe any adverse-effects. Conclusion: These results suggest that repeated sessions of 20 Hz rTMS over M1 are interesting in clinical practice for the treatment of selected patients with central pain. Both the cumulative effects across the first sessions and the long duration of pain-relief should impact further randomized trials that are warranted to conclude formally on rTMS efficiency in central pain.
    Full-text · Article · Jan 2016 · European journal of pain (London, England)
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    • "Cross-sectional epidemiological studies have identified multiple risk factors for neuropathic pain. These include older age, female gender, manual occupation, lower educational attainment, and living in a rural area or in poor accommodation (Smith et al., 2007;Torrance et al., 2006). These risk factors are difficult to modify and are not suitable for clinical intervention, though they are still of academic and political interest . "
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    ABSTRACT: Neuropathic pain is defined as pain arising as a direct consequence of a lesion or a disease affecting the somatosensory system and it affects around 1 in 4 diabetic patients in the UK. The purpose of this genome-wide association study (GWAS) was to identify genetic contributors to this disorder. Cases of neuropathic pain were defined as diabetic patients with a multiple prescription history of at least one of five drugs specifically indicated for the treatment of neuropathic pain. Controls were diabetic individuals who were not prescribed any of these drugs, nor amitriptyline, carbamazepine, or nortriptyline. Overall, 961 diabetic neuropathic pain cases and 3260 diabetic controls in the Genetics of Diabetes Audit and Research Tayside (GoDARTS) cohort were identified. We found a cluster in the Chr1p35.1 (ZSCAN20-TLR12P) with a lowest P value of 2.74 × 10− 7 at rs71647933 in females and a cluster in the Chr8p23.1, next to HMGB1P46 with a lowest P value of 8.02 × 10− 7 at rs6986153 in males. Sex-specific narrow sense heritability was higher in males (30.0%) than in females (14.7%). This GWAS on diabetic neuropathic pain provides evidence for the sex-specific involvement of Chr1p35.1 (ZSCAN20-TLR12P) and Chr8p23.1 (HMGB1P46) with the disorder, indicating the need for further research.
    Full-text · Article · Aug 2015 · EBioMedicine
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