Joint European Academy of Neurology–European Pain Federation–Neuropathic Pain Special Interest Group of the International Association for the Study of Pain guidelines on neuropathic pain assessment

Andrea Truini (1) , Katina Aleksovska (2, 3) , Christopher Anderson (4) , Nadine Attal (5) , Ralf Baron (6) , David Bennett (7) , Didier Bouhassira (5) , Giorgio Cruccu (1) , Elon Eisenberg (8) , Elena Enax-Krumova (9) , Karen Deborah Davis (10, 11) , Giulia Di Stefano (1) , Nanna Finnerup (12) , Luis Garcia-Larrea (13, 14) , Ibrahem Hanafi (15) , Simon Haroutounian (4) , Pall Karlsson (12) , Martin Rakusa (16) , Andrew Rice (17) , Juliane Sachau (6) , Blair Smith (18) , Claudia Sommer (15) , Thomas Tölle (19) , Josep Valls-Solé (20) , Abirami Veluchamy (18)

1 UNIROMA - Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome]
2 Head Office - European Academy of Neurology [Vienna, Austria]
3 Ss. Cyril and Methodius University in Skopje
4 Washington University School of Medicine [Saint Louis, MO]
5 LPPD - Physiopathologie et Pharmacologie Clinique de la Douleur
6 UKSH - University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein
7 University of Oxford
8 Technion - Israel Institute of Technology [Haifa]
9 RUB - Ruhr University Bochum = Ruhr-Universität Bochum
10 Toronto Western Hospital
11 University Health Network [Toronto, ON, Canada]
12 Aarhus University [Aarhus]
13 CRNL - Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
14 Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
15 University Hospital of Würzburg
16 UKC Maribor - University medical centre Maribor
17 Imperial College London
18 University of Dundee
19 TUM - Technische Universität Munchen - Technical University Munich - Université Technique de Munich
20 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer

Abstract Background and Purpose In these guidelines, we aimed to develop evidence‐based recommendations for the use of screening questionnaires and diagnostic tests in patients with neuropathic pain (NeP). Methods We systematically reviewed studies providing information on the sensitivity and specificity of screening questionnaires, and quantitative sensory testing, neurophysiology, skin biopsy, and corneal confocal microscopy. We also analysed how functional neuroimaging, peripheral nerve blocks, and genetic testing might provide useful information in diagnosing NeP. Results Of the screening questionnaires, Douleur Neuropathique en 4 Questions (DN4), I‐DN4 (self‐administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received a strong recommendation, and S‐LANSS (self‐administered LANSS) and PainDETECT weak recommendations for their use in the diagnostic pathway for patients with possible NeP. We devised a strong recommendation for the use of skin biopsy and a weak recommendation for quantitative sensory testing and nociceptive evoked potentials in the NeP diagnosis. Trigeminal reflex testing received a strong recommendation in diagnosing secondary trigeminal neuralgia. Although many studies support the usefulness of corneal confocal microscopy in diagnosing peripheral neuropathy, no study specifically investigated the diagnostic accuracy of this technique in patients with NeP. Functional neuroimaging and peripheral nerve blocks are helpful in disclosing pathophysiology and/or predicting outcomes, but current literature does not support their use for diagnosing NeP. Genetic testing may be considered at specialist centres, in selected cases. Conclusions These recommendations provide evidence‐based clinical practice guidelines for NeP diagnosis. Due to the poor‐to‐moderate quality of evidence identified by this review, future large‐scale, well‐designed, multicentre studies assessing the accuracy of diagnostic tests for NeP are needed.

Mots clés: diagnostic accuracy; diagnostic tests; neuropathic pain.

Domaines: Sciences du Vivant [q-bio]

Andrea Truini, Katina Aleksovska, Christopher Anderson, Nadine Attal, Ralf Baron, et al.. Joint European Academy of Neurology–European Pain Federation–Neuropathic Pain Special Interest Group of the International Association for the Study of Pain guidelines on neuropathic pain assessment. European Journal of Neurology, 2023, 30 (8), pp.2177-2196. ⟨10.1111/ene.15831⟩. ⟨inserm-04238854⟩