Neuropathic pain is a multidimensional entity that continues to present a challenge to medical professionals with regards to its diagnosis and management. In recent years there has been an emphasis on the use of pain descriptors to aid diagnosis, but the lack of pathognomonic terms and overlap of descriptors between neuropathic and nociceptive pain conditions means that neuropathic pain continues to be poorly recognised and under-treated.
The classification of chronic pain falls into three broad categories: pain owing to tissue disease or damage (nociceptive pain, such as osteoarthritis), pain caused by somatosensory system disease or damage (neuropathic pain) and coexistence of nociceptive and neuropathic pain (mixed pain). Various nerve damaging stimuli in the peripheral or central nervous system can lead to neuropathic pain, yet the clinical manifestation of the pain is similar across the different neuropathic syndromes and causes. Patients typically have paradoxical sensory perceptions with pain as a dominating positive symptom combined with lesion-induced reduced sensations.
The characteristic sensory abnormalities are crucial findings to correctly diagnose neuropathic pain and to distinguish this from other pain types. The key challenges in development of a targeted holistic approach to neuropathic pain management include appropriate diagnosis of the cause of pain, identification of the type of pain and assessment of the importance of its various components, and determination of appropriate treatment.