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. 2012 May 28:12:29.
doi: 10.1186/1471-2377-12-29.

Towards a definition of refractory neuropathic pain for epidemiological research. An international Delphi survey of experts

Blair H Smith  1 , Nicola Torrance, Janice A Ferguson, Michael I Bennett, Michael G Serpell, Kate M Dunn
Affiliations

Towards a definition of refractory neuropathic pain for epidemiological research. An international Delphi survey of experts

Blair H Smith et al. BMC Neurol. .

Abstract

Background: Best current estimates of neuropathic pain (NeuP) prevalence come from studies using various screening detecting pain with probable neuropathic features; the proportion experiencing significant, long-term NeuP, and the proportion not responding to standard treatment are unknown. These "refractory" cases are the most clinically important to detect, being the most severe, requiring specialist treatment.

Methods: We report an international Delphi survey of experts in NeuP, aiming for consensus on the features required to define, for epidemiological research: (1) neuropathic pain; and (2) when NeuP is "refractory". A web-based questionnaire was developed and data collected from three rounds of questionnaires from nineteen experts.

Results: There was good consensus on essential inclusion of six items to identify NeuP ("prickling, tingling, pins & needles", "pain evoked by light touch", "electric shocks or shooting pain", "hot or burning" pain, "brush allodynia on self-examination", and "relevant history") and on some items that were non-essential. Consensus was also reached on components of a "refractory NeuP" definition: minimum duration (one year); number of trials of drugs of known effectiveness (four); adequate duration of these trials (three months / maximum tolerated); outcomes of treatment (pain severity, quality of life). Further work needs to validate these proposed criteria in general population research.

Conclusions: This paper presents an international consensus on measuring the epidemiology of refractory neuropathic pain. This will be valuable in reaching an agreed estimate of the prevalence of neuropathic pain, and the first estimate of refractory neuropathic pain prevalence.

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Figures

Figure 1
Figure 1
Flowchart of participants in the study.
Figure 2
Figure 2
Agreement after three rounds with items about pain characteristics that should be included in a neuropathic pain case definition tool for epidemiological use.
Figure 3
Figure 3
Agreement with levels of attributes identified for a definition of refractory neuropathic pain for use in epidemiology research.
See this image and copyright information in PMC

References

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