New Tool Distinguishes Between Subtypes

The researchers studied the symptoms and signs of patients with peripheral neuropathic pain (nerve pain such as sciatica) and non-neuropathic (non-nerve) low back pain to identify the best clinical questions and physical tests for diagnosing pain types.

These questions and tests formed the items contained in the authors' tool for a standardised evaluation of pain (StEP) which they validated among an independent group of patients with chronic back pain. The diagnostic accuracy of StEP exceeded that of a dedicated screening tool for neuropathic pain and spinal magnetic resonance imaging, the authors report, and was well accepted among patients.

Because StEP takes just ten to 15 minutes to administer and can be done at the bedside, the authors say it provides a simple, quick diagnostic procedure that distinguishes between radicular (neuropathic) and axial (non-neuropathic) low back pain. "This distinction is crucial," say the authors, "because back pain is a diagnostic label for a heterogeneous group of patients and it is often difficult to decide which patients will benefit from treatment strategies that target neuropathic pain." Future research on differences between pain subtypes may enable physicians to tailor treatments for chronic pain to individual patients rather than, as is currently the case, largely guessing which of the available treatments is likely to work best.

A recently published review article on tools for assessing neuropathic pain, by researchers who were not involved in developing the new tool, says that "differentiating between nociceptive and neuropathic pain is clinically important because these components require different pain management strategies. The differentiation is also very important for pharmacological trials."; Source: Public Library of Science