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A New de Nition of Neuropathic Pain
A New de Nition of Neuropathic Pain
A New de Nition of Neuropathic Pain
www.elsevier.com/locate/pain
Commentary
0304-3959/$36.00 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2011.06.017
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The lack of structural abnormalities in so-called dysfunctional states (bromyalgia, CRPS, vulvodynia, interstitial cystitis, etc.) prevents us from nding a relationship between structure and function, which is important in the study of a subjective experience such as pain. If some patients with these disorders are found to represent cases of small-ber neuropathies [4,8], then those patients would easily fall under the umbrella of neuropathic pain. By excluding bromyalgia and CRPS from the neuropathic pain syndrome does this imply a risk for not offering these patients a treatment otherwise approved for neuropathic pain? Antidepressants and gabapentinoids with an approved indication for neuropathic pain are nonspecic compounds with a general action on neuronal hyperexcitability. As neuronal hyperexcitability is a mechanism shared by many chronic pain conditions, including bromyalgia and CRPS, treatment with antidepressants and gabapentinoids should denitely not be withheld from patients with these dysfunctional conditions, certainly not because of the current change of the denition of neuropathic pain. 4. Consequence of a restrictive denition of neuropathic pain It may be argued that by excluding syndromes such as CRPS type 1 and bromyalgia from the neuropathic pain group, there is a risk of stigmatizing this group of patients as having a somatization disorder, one without a true and demonstrable abnormality, as opposed to the patients who have a real physical illness. First of all, as pain is dened as what a person experiences, by denition all pain is real and legitimate [7]. The clinical challenge is to identify and ameliorate the cause(s) of the pain, which may be tissue damage, damage to the bodys warning system, both, or neither. We are not doing the patients any good by giving them a diagnostic label for which there is no basis. To include patients suffering from disorders with unexplained mechanisms under a specic label in casu: neuropathic pain will only serve as a sleeping pillow instead of sharpening our diagnostic search and attempts to dissect the underlying mechanisms. Our approach as pain researchers should be consistent with the IASP mission, which is to study the conditions in depth. The new denition offers a platform for doing further research experimentally, clinically, and pharmacologically, so as to better understand neuropathic pain syndromes. Also, it is our hope that the new denition will raise further scientic awareness and thus be an additional step in the direction of keeping up the scientic momentum and moving us from the domain of beliefs into evidence. 5. Conclusion A denition of neuropathic pain is only useful if it distinguishes conditions in a clinically meaningful way. If the denition does not provide additional benet in terms of understanding and treating the condition(s), then there is no reason to keep it. Hopefully, the new denition of neuropathic pain will act as a stimulant to discuss the denition in more detail and provide input for studies that can be used to test the value of the denition.
Conict of interest statement The authors have no conicts of interest to report. References
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Troels S. Jensen Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark Tel.: +45 8949 4137; fax: +45 8949 3269 E-mail address: tsjensen@ki.au.dk Ralf Baron Sektion fr Neurologische Schmerzforschung und -therapie, Klinik fr Neurologie, Universittsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany Maija Haanp Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland Eija Kalso Department of Anaesthesiology, Pain Clinic, Helsinki University, Helsinki, Finland John D. Loeser Department of Neurological Surgery, University of Washington, Seattle, WA, USA Andrew S.C. Rice Pain Research Group, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK Rolf-Detlef Treede Chair of Neurophysiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany