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News&Review No.3

September 2010 l ISSUE NO 3 5 NEWS & REVIEWS Professor Bart Morlion RELEVANCE OF NEUROPATHIC COMPONENTS IN CHRONIC PAIN Chronic back pain is the commonest type of chronic pain1 and can occur through nociceptive, neuropathic and inflammatory processes. Approxi- mately 4% of adults experience chronic back pain with a neuropathic component2 which is caused by dam- age to the nerve fibres with the pain impulse arising from the neuronal structures. This leads to more in- tense pain, more co-morbidity and a poorer quality of life3. To assess the neuropathic compo- nent is difficult but extremely impor- tant if one is to choose the correct pain management therapy for the pa- tient. Differentiating between a neu- ropathic and nociceptive component can be assisted by using the vali- dated painDETECT3 questionnaire in patients with back pain3. However, a survey among participants at the Ex- pert Summit revealed that only 8.2% used it always while 63.3% never used this questionnaire at all show- ing that such assessment methods are still not broadly used in daily practice. Treatment guidelines Through the many guidelines on man- agement of low back pain there is COMMENTARY Professor Bart Morlion, Leuven Centre of Algology and Pain Management, University Hospitals Leuven, Belgium Chronic pain, like low back pain, is multifactorial with many patients exhibiting nociceptive and neuropathic components.The neuropathic compo- nent is especially difficult to assess and to treat. Pharmacological treatment, however, should address the different components underlying the pain in order to offer chronic low back pain patients the optimal therapy available. I therefore highly appreciated the CHANGE PAIN Expert Summit since it enabled professionals in pain treatment to exchange insights from their clinical experience. one common factor that is increas- ingly acknowledged and recom- mended. This is the multi-modal approach achieved through a combi- nation of drug treatment and other strategies such as exercise, educa- tion and psychological counselling. Recent guidelines also address in par- ticular the treatment of neuropathic components. However, there is in- creasing recognition that chronic back pain treatment with current therapies such as muscle relaxants, NSAIDs, opioids and antidepressants, both singly and in combination, often leads to non-compliance and treatment dis- continuation4. In conclusion more targeted treatment will be required to improve individual patient outcomes. Therefore, identifi- cation of the individual’s underlying pain mechanisms is crucial but difficult as there is no consistent correlation in patients with back pain. However, the possible components need to be considered in order to choose an adequate treatment option4. References 1. Breivik H et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain, 2006, 10(4): 287-333. 2. Schmidt CO et al. Modelling the prevalence and cost of back pain with neuropathic components in the general population. Eur J Pain, 2009, 13(10): 1030–1035. 3. Freynhagen R et al. painDETECT: a new screen- ing questionnaire to identify neuropathic compo- nents in patients with back pain. Curr Med Res Opin, 2006, 22(10): 1911-1920. 4. Varrassi G et al. Pharmacological treatment of chronic pain – the need for CHANGE. Curr Med Res Opin, 2010, 26(5):1231-1245.