Clinical assessment and diagnostic work-up

Roman Rolke

in Neuropathic Pain

Second edition

Published on behalf of Oxford University Press

ISBN: 9780199563678
Published online May 2011 | e-ISBN: 9780199607426 | DOI:

Series: Oxford Pain Management Library

Clinical assessment and diagnostic work-up

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• Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system • The diagnostic work-up of neuropathic pain syndromes includes information on the patient’s history and a bedside examination focussed on the main questions: • Is the distribution of pain and sensory deficit neuroanatomically logical? • Is the disease history suggestive of a relevant lesion or disease to the peripheral or central somatosensory system? • Common neuropathic pain symptoms are spontaneous pain (ongoing pain without detectable stimulation) and evoked pains (abnormal responses to stimulation) • Clinical signs such as hyperalgesia, allodynia, or hypoalgesia and hypoesthesia may indicate possible underlying neurobiological pain mechanisms such as peripheral/central sensitization or deafferentation of the nociceptive system • Conventional electrophysiology (nerve conduction studies and somatosensory-evoked potentials) are objective measures mainly confirming a large fibre sensory deficit. Small fibre function usually escapes these conventional methods • Quantitative sensory testing (QST) is the analysis of the subjective response to a somatosensory perception after external stimuli of controlled intensity. Using QST it is possible to assess both small fibre function as well as positive and negative sensory phenomena.

Chapter.  2516 words.  Illustrated.

Subjects: Anaesthetics ; Pain Medicine

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