Neurológia pre prax 5/2020

Evaluating a patient with neuropathic pain in a neurological outpatient practic

Pain represents one of the most frequent clinical symptoms. According to the recent epidemiological studies, most of one third of neurological patients suffer from pain. Both the neuropathic and/or nociceptive pain may occure in neurological patients and their differentiation is highly important (among others due to their different treatment). The diagnostic process in pain patient consists from several steps. The first one is based on the data from medical history and is focused on history of relevant neurological lesion or disease and presence of pain in neuroanatomically plausile distribution, and also on the pain character and intensity and pain-worsening or relieving factors. Clinical neurological examination confirming the presence of sensory signs in the distribution of pain represents the second step. Finally, the third step is based on the confirmation of the lesion/disease of somatosensory nervous system using imaging, electrophysiological, neuropathological or genetic tests. In neuropathic pain patients, these steps allow the stratification into possible, probable, and definite diagnosis.

Keywords: pain, neuropathic pain, medical history, questionnaire, sensory examination