1. Gli Strumenti di Screening devono essere applicati nella diagnosi di DN? Si Nadine Attal No Sandrini Discussant Brigida Fierro, Angelo Quartarone Incontro Nazionale Neurofisiologia: Nuove Strategie Controversie sulla diagnosi e terapia del dolore neuropatico Palermo, 29-30 novembre 2012

2. Premesse: Il Topic Brigida Fierro Dipartimento BioNec Università degli studi di Palermo Palermo, 29-30 novembre 2012

3. Neuropathic Pain: definition Neurology.Neurology. 2008 Apr 29;70(18):1630-5. Epub 2007 Nov 14. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Treede RDTreede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J.Jensen TSCampbell JNCruccu GDostrovsky JOGriffin JWHansson PHughes RNurmikko TSerra J The International Association for the Study of Pain (IASP 1994) introduced the term neuropathic pain, defined as " pain initiated or caused by a primary lesion or dysfunction in the nervous system." While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain, it lacks defined boundaries. The Neurophatic pain Special interest group (NeuPSIG 2008) present a more precise definition : pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. so including a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain. Palermo, 29-30 novembre 2012

5. The challenge is: to differentiate neuropathic pain from other types of pain and then to diagnose the lesion or disease causing the pain. Palermo, 29-30 novembre 2012 Neuropathic Pain

6. Methods of assessing nerve function (1) bedside examination, which relies on the physician's experience and the patient's ability and willingness to collaborate; (2) quantitative sensory testing, a measure that despite using quantitative, graded stimuli also relies on the patient's evaluation; (3) laboratory tests use quantitative tools and measure an objective responses.

7. The challenge is: first step to differentiate neuropathic pain from other types of pain and then to diagnose the lesion or disease causing the pain. Palermo, 29-30 novembre 2012 Neuropathic Pain

8. Grading system of neuropathic pain (NeuPSIG 2008) Palermo, 29-30 novembre 2012 Treede et al Neurology 2008

9. Pain is a subjective condition that cannot be objectively measured; for this reason, self patient-perspective is crucial to evaluate: character (quality, intensity,temporal aspects, stimulus-dependent or not etc.) distribution of pain (confined to innervation territory of the affected nervous structure) Presence of positive or negative symptoms or signs. Neuropathic vs. nociceptive Pain

10. recently, several screening tools have been developed essentially to discriminate between nociceptive and neuropathic pain Screening tools Based on pain descriptors

11. Modern Screening tools Palermo, 29-30 novembre 2012

12. se il punteggio del paziente è uguale o maggiore di 4/10, il test è positivo (sensibilità=82,9%; specificità=89,9%) Bouhassira et., 2005; versione italiana a cura di Caraceni, Zecca e Martini) Le Douleur Neuropathique 4 DN4: Italian Version Physician Examination Interview Subjective measures

13. identify patients with possible neuropathic pain. are easy to use provide immediately available informations are useful for research pourposes PearlsPitfalls Screening tools fail to identify abot 10- 20% of patients with clinical diagnosed neuropahic pain so cannot replace clinical judgment

14. Screening Tools The questions are: are they useful in the real life or only for clinical trials? do they identify subtypes of neuropathic pain? can they be used to assess the effects of treatment? should also be used to predict treatment outcome and better define responder profiles to treatment?