期刊
EUROPEAN JOURNAL OF NEUROLOGY
卷 17, 期 8, 页码 1010-1018出版社
WILEY-BLACKWELL
DOI: 10.1111/j.1468-1331.2010.02969.x
关键词
evoked potentials; functional neuroimaging; neuropathic pain; quantitative sensory testing; screening tools; skin biopsy
Background and purpose: We have revised the previous EFNS guidelines on neuropathic pain (NP) assessment, which aimed to provide recommendations for the diagnostic process, screening tools and questionnaires, quantitative sensory testing (QST), microneurography, pain-related reflexes and evoked potentials, functional neuroimaging and skin biopsy. Methods: We have checked and rated the literature published in the period 2004-2009, according to the EFNS method of classification for diagnostic procedures. Results: Most of the previous recommendations were reinforced by the new studies. The main revisions relate to: (i) the new definition of NP and a diagnostic grading system; (ii) several new validated clinical screening tools that identify NP components, and questionnaires which assess the different types of NP; (iii) recent high-quality studies on laser-evoked potentials (LEPs) and skin biopsy. Conclusions: History and bedside examination are still fundamental to a correct diagnosis, whilst screening tools and questionnaires are useful in indicating probable NP; QST is also useful for indicating the latter, and to assess provoked pains and treatment response. Amongst laboratory tests, LEPs are the best tool for assessing A delta pathway dysfunction, and skin biopsy for assessing neuropathies with distal loss of unmyelinated nerve fibres.
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