Can the neuropathic pain scale discriminate between non-neuropathic and neuropathic pain?

OBJECTIVES: 1) To determine if the neuropathic pain scale (NPS) can be used to classify chronic pain patients (CPPs) as having primarily neuropathic vs non-neuropathic pain, and furthermore; 2) to determine what, if any, cut-off score can be used to reliably make this determination. DESIGN: A total of 305 CPPs consecutive admissions to The Rosomoff Pain Center were administered the NPS and were assigned a diagnosis according to the physical examination and all available test results. CPPs with a diagnosis of chronic radiculopathy and spondylolysis/degenerative arthritis were segregated into two groups for the purposes of having a group representative of neuropathic pain (chronic radiculopathy) and non-neuropathic pain (spondylolysis/degenerative arthritis). Applying neuropathic pain criteria to each "of these two groups": a neuropathic pain "subtype" was identified within the chronic radiculopathy group; and, a non-neuropathic pain "subtype" was identified within the spondylolysis/degenerative arthritis group. This step was performed in order to assure that the CPPs selected for further analysis were truly representative of neuropathic and non-neuropathic pain. Discriminant function analysis was then employed to determine if NPS scoring could differentiate between these two "subtypes." Results from the discriminant function analysis model were utilized to derive an NPS cut-off score above which CPPs would be classified as having neuropathic pain. For the diagnoses of myofascial pain syndromes, spinal stenosis, epidural fibrosis, fibromyalgia, complex regional pain syndromes 1 and 2, and failed back surgery syndrome, a predicted NPS score was calculated and compared with the cut-off score. SETTING: Multidisciplinary pain facility. PATIENTS: Chronic pain patients. RESULTS: The NPS appeared to be able to separate CPPs into neuropathic pain vs non-neuropathic pain subtypes. The derived cut-off score from the model was 5.53. Myofascial pain syndrome and spinal stenosis had predictive scores lower than this cut-off score at 3.81 and 4.26, respectively. Epidural fibrosis, fibromyalgia, complex regional pain syndromes 1 and 2, and failed back surgery syndrome had predictive scores higher than the cut-off score at 6.15, 6.35, 6.87, 9.34, and 7.19, respectively. CONCLUSIONS: The NPS appears to be able to discriminate between neuropathic and non-neuropathic pain. A debate is currently raging as to whether diagnoses, such as fibromyalgia and complex regional pain syndrome 1, can be classified as neuropathic. Our NPS cut-off score results suggest that these diagnoses may have a neuropathic pain component. The reliability and validity of our NPS method will need to be tested further in other neuropathic pain models, such as diabetic peripheral neuropathic pain.

[Rehabilitation method for churg-strauss syndrome from early stage: considering functional prognosis of mononeuritis multiplex].

We report our rehabilitation experience for two patients with Churg-Strauss syndrome (CSS). To improve their functional prognoses, we started rehabilitation program compensating for their activity of daily livings from their early stage. Also, we paid special attention to prescribed drug effect and adverse effect. Since patients with the mononeuritis multiplex have restricted weakness in the muscles ruled by a specific nerve, rehabilitation approaches including orthoses should start to improve the compensatory ability of normal adjacent muscles even in their early stages. In addition, since functional improvement may be gradual and take some years from onset, we should start rehabilitation in their early stage to improve their functional prognoses.

[The laser therapy of median nerve neuritis in a biocontrol mode]. / Lazerterapiia nevrita sredinnogo nerva v rezhime bioupravleniia.

Treatment of neuritis of nervus medianus goes on much faster if biocontrolled regimen of laser therapy synchronization with blood rhythms of the patient is introduced. Estimation of the nervus conductivity recovery rate and muscular contractility was based on the data obtained at broadened electrodiagnosis with sinusoidal modulated currents.

Posttraumatic childhood lumbosacral plexus neuropathy.

A 13-month-old male received crush injury to the abdomen resulting in paraparesis due to lumbosacral plexus neuropathy. The child was monitored with serial clinical examinations and electromyography/nerve conduction studies. He had complete clinical recovery. Lumbosacral plexus neuropathy is unusual in childhood and has not been previously reported as a result of abdominal trauma. This patient is presented with details of the clinical course, electrodiagnostic studies, discussion, and literature review.

[The rehabilitation of patients with postneuritic contracture of the mimetic muscles by using locally applied cold action]. / Reabilitatsiia bol'nykh postnevriticheskoi kontrakturoi mimicheskikh myshts s primeneniem lokal'nogo dozirovaniia kholodovogo vozdeistviia.

A method is proposed for combined modality treatment of patients with postneuritic contracture of the muscles of expression of various genesis utilizing local hypothermia as well as hypo- and hyperthermic methods of treatment. Clinical effectiveness of the proposed method of treatment of patients in the acute phase of the facial nerve neuritis, non-existence of important contraindications which are usual with the medicamentous and electrophysiotherapeutic methods of treatment of this condition, and absence of supposed complications enable it to be recommended for clinical application.

Prolonged dysequilibrium in three cases with vestibular neuronitis: efficacy of vestibular rehabilitation.

The clinical course of acute unilateral vestibular disturbance in 3 cases with vestibular neuronitis and a case with labyrinthine destruction was surveyed for a long-term period. Vestibular training with a modified Cawthorne-Cooksey's exercise was done in 2 of 3 cases with vestibular neuronitis and a case of labyrinthine destruction. All had no severe troubles in activities of their daily lives over one year after the onset of the disease, but the central compensation was not completed, even in a young patient, in a case of labyrinthine destruction and in a well trained case. Spontaneous nystagmus to the affected side and increase of body sway with eyes closed were revealed by examinations in all cases. Physical exercise was found to be effective for relief from vestibular ataxia, but it was difficult to keep the effect even after training.

[Integrative index of the results of functional studies in patients with neuritis of the radial nerve during rehabilitation]. / Integrativnyi pokazatel' rezul'tatov funktsional'nykh issledovanii u bol'nykh s nevritom luchevogo nerva v protsesse reabilitatsii.

The authors propose a principle of a comprehensive approach to the assessment of neuromuscular and hemodynamic disorders in patients with radial neuritis of nontraumatic genesis. It has been established that the integrative parameter of the results of functional studies makes it possible to predict the outcome of the disease and to objectively evaluate the severity of the disease and the adequacy of the rehabilitation treatment.