Symptom Profiles Differ in Patients With Neuropathic Versus Non-neuropathic Pain

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J Pain. 2006 Aug 30

Symptom Profiles Differ in Patients With Neuropathic Versus Non-

neuropathic Pain.

Dworkin RH, Jensen MP, Gammaitoni AR, Olaleye DO, Galer BS.

Departments of Anesthesiology and Neurology, University of Rochester

School of Medicine and Dentistry, Rochester, New York.

The distinction between neuropathic and non-neuropathic pain reflects

partially distinct mechanisms and patterns of treatment response. It

was therefore hypothesized that patients with neuropathic and non-

neuropathic pain have different profiles of symptoms and signs. To

test this hypothesis, pain intensity, unpleasantness, quality, and

spatial characteristics were examined in 618 patients with 1 of 3

peripheral neuropathic pain conditions (painful diabetic peripheral

neuropathy, painful idiopathic sensory polyneuropathy, or

postherpetic neuralgia), osteoarthritis pain, or low back pain.

These assessments were conducted before treatment had begun in

clinical trials of lidocaine patch 5% administered alone or with

stable dosages of other analgesics. Patients with osteoarthritis pain

and low back pain did not differ in their profile of pain quality and

spatial characteristics and were combined to form a group of patients

with non-neuropathic pain.

In univariate analyses, patients with peripheral neuropathic pain

reported significantly more intense hot, cold, sensitive, itchy, and

surface pain and significantly less intense dull and deep pain than

patients with non-neuropathic pain. In a multivariate analysis, the

overall pattern of pain quality and spatial characteristics differed

significantly between patients with neuropathic and non-neuropathic

pain. In addition, specific pain quality and spatial characteristics

improved the discrimination of patients with neuropathic and non-

neuropathic pain in a logistic regression model that adjusted for

demographic covariates and overall pain intensity and unpleasantness.

PERSPECTIVE: The results indicate that the distinction between

neuropathic and non-neuropathic pain is reflected in different

profiles of pain quality and spatial characteristics and suggest that

the assessment of patterns of pain symptoms might contribute to the

identification of distinct pathophysiologic mechanisms and the

development of mechanism-based treatment approaches.