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ISSUE NO 1 11 NEWS & REVIEWS PainDETECT: a new screening questionnaire to identify neuro- pathic components in patients with back pain Freynhagen R, Baron R, Göckel U,TolleT. Current Medical Research and Opinions, 2006, 22:1911-1920 Nociceptive and neuropathic com- ponents both contribute to pain and since these components require dif- ferent pain management strategies, correct pain diagnosis is important. The painDETECT questionnaire (PD- Q) was developed as a validated screening tool to detect neuropathic pain components in chronic low back pain (LBP) patients. It was used in a prospective, multicentre study and subsequently applied to approximately 8,000 LBP patients. The study showed that patients ul- timately report symptoms rather than pain mechanisms, therefore screening tools that identify neuro- pathic pain on the basis of symp- toms and signs seems rational. The data demonstrated that about 2/3 of the patient population had predominantly neuropathic pain or pain with a neuropathic component whereas only about 1/3 had suf- fered from predominantly nocicep- tive pain. The distinction between neuro- pathic and nociceptive pain types and the estimation of its relevance are important, since different pain types require different therapeutic approaches. This paper has demon- strated that the prevalence of neu- ropathic pain components correlates with more intense pain, more se- vere co-morbidity and poorer qual- ity of life. Therefore, accurate diagnosis is a milestone in choos- ing appropriate therapy. Prescription patterns of chronic pain differs markedly across Europe Data for the year 2008 from IMS Health (International Medical Statistics) IMS, an internationally accepted in- formation provider, shows huge dif- ferences in the consumption of analgesics across Europe, both in quantity and the type of agent pre- scribed. Specifically in the use of opioids large differences exist and they are prescribed much more fre- quently in Northern Europe com- pared to Southern and Eastern Europe. A recently conducted GFK market research study among 996 physicians of different specialities in Germany, UK, France, Spain, Italy, Sweden and Denmark confirms that prescription patterns for chronic pain treatment differs markedly across Europe. For example, in Germany severe chronic low back pain patients are treated with a combination of an opioid and one or two co-analgesics. Multiple medications are used in the UK, includingTCAs, anticonvulsants and strong opioids, although 39% of patients receive codeine.The Spanish approach is to give strong opioids, possibly with an anticonvulsant, while very few opioids, especially strong opioids, are prescribed in Italy. Tramadol is incorporated into treatment at an early stage in France. Several interviewees in Denmark prescribe strong opioids, compared to a higher usage of weak opioids in Sweden.This wide range of approaches reflects the difficulty of relieving severe chronic low back pain. Modelling the prevalence and cost of back pain with neuro- pathic components in the general population Schmidt C, Schweikert B,Wenig C et al.. European Journal of Pain, 2009, doi: 10. 1016 / j.epain.2008.12.003 This study aimed to estimate the prevalence of neuropathic compo- nents in back pain and to assess the proportion of direct and indirect as- sociated costs. Data from three studies: painDETECT 1, painDE- TECT 2, and the German back pain research network (GBPRN) study were combined, representing a total of 21,047 subjects. A strong association between pain severity and the proportion of patients with neuropathic pain components was found. Neuropathic pain compo- nents were substantially more fre- quent in persons with severe back pain (up to 77%) compared to per- sons with mild back pain.The model suggests that almost one in five adults with persistent back pain ex- periences neuropathic pain symp- toms, which would correspond to approximately 4% of the general adult population. Among patients with persistent back pain, typical costs associated with a person suf- fering neuropathic back pain were significanty higher than those of an average back pain patient, and those patients with nociceptive pain only. Back pain with neuropathic compo- nents is likely to affect a relevant proportion of the general adult pop- ulation and cause a disproportion- ately high share of back pain-related costs. The identification and ade- quate treatment of back pain with neuropathic components could have a beneficial economic impact. SUMMARY OF PUBLICATIONS