Neuropathic pain

Redefinition and a grading system for clinical and research purposes

R. D. Treede, T. S. Jensen, James N Campbell, G. Cruccu, J. O. Dostrovsky, J. W. Griffin, P. Hansson, R. Hughes, T. Nurmikko, J. Serra

Research output: Contribution to journalArticle

Abstract

Pain usually results from activation of nociceptive afferents by actually or potentially tissue-damaging stimuli. Pain may also arise by activity generated within the nervous system without adequate stimulation of its peripheral sensory endings. For this type of pain, the International Association for the Study of Pain 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. Since the sensitivity of the nociceptive system is modulated by its adequate activation (e.g., by central sensitization), it has been difficult to distinguish neuropathic dysfunction from physiologic neuroplasticity. We present a more precise definition developed by a group of experts from the neurologic and pain community: pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. This revised definition fits into the nosology of neurologic disorders. The reference to the somatosensory system was derived from a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain. Because of the lack of a specific diagnostic tool for neuropathic pain, a grading system of definite, probable, and possible neuropathic pain is proposed. The grade possible can only be regarded as a working hypothesis, which does not exclude but does not diagnose neuropathic pain. The grades probable and definite require confirmatory evidence from a neurologic examination. This grading system is proposed for clinical and research purposes.

Original languageEnglish (US)
Pages (from-to)1630-1635
Number of pages6
JournalNeurology
Volume70
Issue number18
DOIs
StatePublished - Apr 2008

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Neuralgia
Pain
Research
Nervous System
Central Nervous System Sensitization
Nociceptive Pain
Neuronal Plasticity
Neurologic Examination
Nervous System Diseases

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Treede, R. D., Jensen, T. S., Campbell, J. N., Cruccu, G., Dostrovsky, J. O., Griffin, J. W., ... Serra, J. (2008). Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology, 70(18), 1630-1635. https://doi.org/10.1212/01.wnl.0000282763.29778.59

Neuropathic pain : Redefinition and a grading system for clinical and research purposes. / Treede, R. D.; Jensen, T. S.; Campbell, James N; Cruccu, G.; Dostrovsky, J. O.; Griffin, J. W.; Hansson, P.; Hughes, R.; Nurmikko, T.; Serra, J.

In: Neurology, Vol. 70, No. 18, 04.2008, p. 1630-1635.

Research output: Contribution to journalArticle

Treede, RD, Jensen, TS, Campbell, JN, Cruccu, G, Dostrovsky, JO, Griffin, JW, Hansson, P, Hughes, R, Nurmikko, T & Serra, J 2008, 'Neuropathic pain: Redefinition and a grading system for clinical and research purposes', Neurology, vol. 70, no. 18, pp. 1630-1635. https://doi.org/10.1212/01.wnl.0000282763.29778.59
Treede, R. D. ; Jensen, T. S. ; Campbell, James N ; Cruccu, G. ; Dostrovsky, J. O. ; Griffin, J. W. ; Hansson, P. ; Hughes, R. ; Nurmikko, T. ; Serra, J. / Neuropathic pain : Redefinition and a grading system for clinical and research purposes. In: Neurology. 2008 ; Vol. 70, No. 18. pp. 1630-1635.
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