Are there any screening tools to help diagnose neuropathic pain?

Various screening tools are available to help physicians diagnose neuropathic pain. The European Federation of Neurological Societies (EFNS) has recently published updated guidelines that provide an overview of, and recommendations on, the key screening tools. These tools are: the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)2; Neuropathic Pain Questionnaire (NPQ)3; Douler Neuropathique en 4 questions (DN4)4; PainDETECT5; ID Pain6; and the standardized evaluation of pain (StEP)7. All these screening tools have been validated in various neuropathic pain populations; the LANSS, DN4 and StEP utilize interview questions and physical examination, while the NPQ, PainDETECT and ID Pain use only interview questions. Of relevance to the Hong Kong population, one of the screening tools – the ID Pain – has been translated to and validated. The validity of the 6-item patient-completed questionnaire was assessed in 92 patients with either neuropathic or nociceptive pain. At a score of 3 or more, the questionnaire correctly classified 71% of cases. While screening tools are useful for identifying patients with possible neuropathic pain, particularly by non-specialist physicians, they do have limitations. As noted in the EFNS guidelines, these tools fail to identify 10–20% of patients with physician-diagnosed neuropathic pain; hence, they should be used together with a thorough patient history and physical examination.

ID pain

1 Did the pain feel like pins and needles? 您的痛楚是否好像被針刺般疼痛？

2 Did the pain feel hot/burning? 您的痛楚是否灼熱或好像被火燒一樣？

3 Did the pain feel numb? 您的痛楚是否帶有麻痺？

4 Did the pain feel like electrical shocks? 您的痛楚是否好像觸電一樣？

5 Is the pain made worse with the touch of clothing or bedsheets? 您的痛楚是否因觸碰衣服或床單而加劇？

6 Is the pain limited to your joints? 您的痛楚是否只限於關節部位？

Reference: http://www.neuropainhk.org

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your doctor immediately.

Back Pain and Degenerative Disc Disease: Are Artificial Discs the Solution?

There has been considerable excitement among surgeons as well as patients following the recent FDA (Food and Drug Administration) release. The excitement among patients with degenerative disc disease stems from the impression that there is now a safe way to eliminate pain from degenerative discs while at the same time maintaining normal motion. Many of these patients have heard about others with similar problems undergoing fusion procedures in the past, who still continue with persistent pain or had more than one attempt at fusion without success or have developed additional levels of disc degeneration requiring an additional fusion procedure. They have also heard of the successful results following disc arthroplasty in Europe which has been highly publicized by the media in the United States. 

Early Detection and Lumbar Fusions
This is definitely an exciting new addition to our armamentarium for the treatment of degenerative disc disease. When we look at how the evaluation and treatment for degenerative disc disease has developed over the past few years an almost unbelievable amount of progress has been made. We now are better able to identify disc disease early on with MRI and pain generators with discography and facet blocks. Where only a decade ago, lumbar fusions were being performed through large posterior incisions, now they can be performed percutaneously through incisions that are barely visible either anteriorly through the abdomen or through the back. With the use of presently available instrumentation, success rates for one level fusions approach 90-95%. Unfortunately, not every patient who has degenerative disc disease and has a successful fusion has a successful clinical result. There is still a group of patients for whom fusion does not effectively alleviate pain.

Disc Replacement: Risks
Disc replacement arthroplasty has the potential for the treatment of many of the spinal motion segment disorders that are currently being treated both successfully and not so successfully by one of the many fusion techniques. At this relatively early stage of disc replacement development, we do not know all of the problems that may be encountered following these procedures. Because the surgical approach is through the abdomen either retroperitoneal or transperitoneal (around/through the stomach), there are some predictable complications including vascular injury, thrombophlebitis (vein inflammation accompanied by blood clot formation), nerve root injuries, injury to the ureter, and retrograde ejaculation in males.

We also know that a number of disc replacements have failed and have been converted to a fusion with variable clinical outcomes. The removal of artificial discs, especially at the L4-5 level, is fraught with a significant risk of vascular injury because of scarring around the prosthesis. We do not know at the present time how long these prostheses will last and how well they will function. Will they provide enough motion to prevent adjacent segment degeneration, and will the patient with multilevel disease be a candidate for this procedure? Certainly we know that artificial joints produce wear debris and an inflammatory response which escalates over time where this is obviously not a problem with fusion. 

Optimism and Early Results
Spine surgeons in general are very optimistic and excited about total disc arthroplasty and appropriately so. There also will be a learning curve by both the spine surgeon as well as the access surgeons who provide the exposure. Appropriate training via courses and cadaveric labs will help to minimize the learning curve and potential complications. There will no doubt be many improvements and modifications in the prosthetic designs.

Early results are certainly encouraging in the hands of the investigational surgeons but are fraught with the many problems common to the development of a new procedure. Total disc arthroplasty is likely to be a better solution than fusion for many degenerative disorders of the lumbar spine as design improvements continue to be made and as further experience defines the indications for its use.

Reference source: http://www.spineuniverse.com/treatments/emerging/artificial-discs/back-pain-degenerative-disc-disease-artificial

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

What is neurosurgery? And what is the neurosurgeon do?

Neurosurgery is a specialty of surgery which provides the critical care, prevention, diagnosis, evaluation, treatment, and rehabilitation of neurological disorders. This includes the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify the function or activity of the nervous system, including the hypophysis and the operation and non-operative treatment of pain. As such, neurosurgery encompasses treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, and the skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland, disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.

What is neurosurgeon?

Neurosurgeon is a surgical doctor specialized in neurological disorders.

Central Nervous System (CNS) disorders - Stroke, Parkinsonism disease, Dementia, Brain tumors, Acoustic neuroma, Arteriole-venous malformation (AVM), etc...

Peripheral Nervous System (PNS) disorders – like Back pain, Scoliosis, Sciatica, Low back pain, Neck pain, Neuropathic pain, etc…  .

Reference information: www.brain-spine.com.hk, http://www.surgery.cuhk.edu.hk/neuro/default.htm

The information above is used for educational purpose only, for any enquiries, please consult your neurosurgeon for medical advices.