Careful questions and everyday objects – the essential tool kit to diagnose neuropathic pain
Reflecting the updated international definition ‘neuropathic pain is caused by a lesion or disease of the somatosensory system’, the program offers education, resources and tools to help doctors distinguish neuropathic pain from other pain conditions.
Dr Andrew Boyden, medical advisor with NPS MedicineWise, says, “Neuropathic pain can be difficult to diagnose. Our program emphasises the need to take a targeted history combined with a simple sensory examination that uses readily available tools – a toothpick, cotton wool and/or a brush. Generally, this approach can be used to confidently diagnose probable neuropathic pain – and further investigations are often not necessary.”
Neuropathic pain can cause significant distress for 1 in 20 Australians and determining whether pain is neuropathic ensures those patients with the condition receive appropriate treatment and avoid unnecessary and ineffective use of pain medications for nociceptive pain. With regards to pharmacological management of neuropathic pain, the program reminds health professionals that in suitable patients, amitriptyline remains a first-line option according to Australian and international guidelines.
The program recommendations for the management of neuropathic pain note that all medications indicated for treating the condition have limitations in terms of their efficacy and that there is significant variation between individuals with regard to the extent to which they may get pain relief from their use.
Dr Boyden says, “Apart from medication use, we emphasise the importance of taking a broader approach to pain management, referring to physical activity as well psychological techniques such as cognitive behavioural therapy and meditation. This will help sufferers to understand and cope with their condition.”
Dr Boyden also notes that pregabalin isn’t useful in a diagnostic capacity, “because of the variable response people with neuropathic pain have to it”.
The program also refers to the use of pregabalin for non-neuropathic pain conditions such as back pain without a neuropathic component, where current evidence does not support its use. The Faculty of Pain Medicine (ANZCA), through the Choosing Wisely Australian initiative, has released a recommendation to avoid prescribing pregabalin or gabapentin for pain which does not fulfil the criteria of neuropathic pain.
Following PBS listing in March 2013, prescriptions of pregabalin have increased from 200,000 in 2012–13 to 3.61 million in 2016–17.
CPD points are available for GPs and nurses when an education visits on the topic ‘Neuropathic Pain: touchpoints for diagnosis and management’ are organised. Book here.
Media enquiries: Eve Hanks (02) 8217 9667, 0419 618 365 or [email protected]