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Is neuropathic pain an acute problem?
Acute Pain 4 (2002) 43
Editorial
Is neuropathic pain an acute problem? Many readers might be surprised to find in this issue of Acute Pain a paper on neuropathic pain [1]. This surprise will result from the fact that neuropathic pain is commonly regarded as a problem for chronic pain specialists. Readers might, therefore, begin to worry that this journal is shifting its focus and becoming one of the many other pain journals. However, on a second look all readers will understand the relevance of this publication. It identifies clearly that a small but considerable number of patients seen by acute pain services are suffering from neuropathic pain. As the director of an acute pain service, I would even dare to claim that the 1–3% incidence of neuropathic pain reported in this study is possibly an underestimation. I personally think that neuropathic pain becomes the more obvious, the more carefully we look. This is in particular true in patients after trauma, who are in this study, too, identified as the largest group of patients suffering from neuropathic pain. Neuropathic pain, therefore, presents a specific challenge to acute pain services; the pain is not only unusually severe as again reported in this study, but is also very difficult to treat. In particular, standard tools of acute pain services such as non-steroidal anti-inflammatory drugs and opioids are often not sufficient or not effective at all in the setting of neuropathic pain. The authors stress again that treatment of neuropathic pain with appropriate methods at an early stage of disease is not only essential to achieving good pain control and reducing suffering in these patients, but is also extremely important with regard to the prevention of long-term chronic pain. The authors here could show that acute neuropathic pain results in a 56% incidence of persistent pain at 12 months review. This is in line with many other observations in similar groups of patients that have identified nerve pain as the trigger for long lasting pain problems. This is in particular obvious in the setting of post-amputation pain; stump pain of
neuropathic origin and phantom limb pain present not only challenges in the acute management, but have also an extremely high likelihood of developing into chronic pain states, which are then often not amenable to any therapeutic intervention. In conclusion, this paper on neuropathic pain in the acute pain service is of utmost importance as it identifies a conservative estimate of 1–3% of patients of an acute pain service presenting with neuropathic pain, leading to chronic persistent pain 1 year later in more than 50% of these patients. I think this is a wake-up call for all of us looking after acute pain patients. We are obliged to diagnose neuropathic pain earlier and more appropriately and then to draw the correct conclusions with regard to specific management. In this context, the recently published book reviewed in this issue gives valuable information on the pathophysiology, diagnosis and treatment of such neuropathic pain [2]. It is most likely here that the concept of pre-emptive analgesia in the wider sense, preventing chronic pain by treating acute pain properly, will be of the most value. References [1] C. Hayes, S. Browne, G. Lantry, R. Burstal, Neuropathic pain in the acute pain service: a prospective survey, Acute Pain 4 (2002) 45–48. [2] S.A. Schug, Mechanisms and Mediators of Neuropathic Pain, Acute Pain 4 (2002) 77.
Stephan A. Schug Anaesthesia and Pain Medicine University of Western Australia and Royal Perth Hospital, Perth, WA 6847, Australia Tel.: +61-8-9224-0201; fax: +61-8-9224-0279 E-mail address: [email protected] (S.A. Schug)
1366-0071/02/$ – see front matter © 2002 Elsevier Science B.V. All rights reserved. PII: S 1 3 6 6 - 0 0 7 1 ( 0 2 ) 0 0 0 2 8 - 1
Editorial
Is neuropathic pain an acute problem? Many readers might be surprised to find in this issue of Acute Pain a paper on neuropathic pain [1]. This surprise will result from the fact that neuropathic pain is commonly regarded as a problem for chronic pain specialists. Readers might, therefore, begin to worry that this journal is shifting its focus and becoming one of the many other pain journals. However, on a second look all readers will understand the relevance of this publication. It identifies clearly that a small but considerable number of patients seen by acute pain services are suffering from neuropathic pain. As the director of an acute pain service, I would even dare to claim that the 1–3% incidence of neuropathic pain reported in this study is possibly an underestimation. I personally think that neuropathic pain becomes the more obvious, the more carefully we look. This is in particular true in patients after trauma, who are in this study, too, identified as the largest group of patients suffering from neuropathic pain. Neuropathic pain, therefore, presents a specific challenge to acute pain services; the pain is not only unusually severe as again reported in this study, but is also very difficult to treat. In particular, standard tools of acute pain services such as non-steroidal anti-inflammatory drugs and opioids are often not sufficient or not effective at all in the setting of neuropathic pain. The authors stress again that treatment of neuropathic pain with appropriate methods at an early stage of disease is not only essential to achieving good pain control and reducing suffering in these patients, but is also extremely important with regard to the prevention of long-term chronic pain. The authors here could show that acute neuropathic pain results in a 56% incidence of persistent pain at 12 months review. This is in line with many other observations in similar groups of patients that have identified nerve pain as the trigger for long lasting pain problems. This is in particular obvious in the setting of post-amputation pain; stump pain of
neuropathic origin and phantom limb pain present not only challenges in the acute management, but have also an extremely high likelihood of developing into chronic pain states, which are then often not amenable to any therapeutic intervention. In conclusion, this paper on neuropathic pain in the acute pain service is of utmost importance as it identifies a conservative estimate of 1–3% of patients of an acute pain service presenting with neuropathic pain, leading to chronic persistent pain 1 year later in more than 50% of these patients. I think this is a wake-up call for all of us looking after acute pain patients. We are obliged to diagnose neuropathic pain earlier and more appropriately and then to draw the correct conclusions with regard to specific management. In this context, the recently published book reviewed in this issue gives valuable information on the pathophysiology, diagnosis and treatment of such neuropathic pain [2]. It is most likely here that the concept of pre-emptive analgesia in the wider sense, preventing chronic pain by treating acute pain properly, will be of the most value. References [1] C. Hayes, S. Browne, G. Lantry, R. Burstal, Neuropathic pain in the acute pain service: a prospective survey, Acute Pain 4 (2002) 45–48. [2] S.A. Schug, Mechanisms and Mediators of Neuropathic Pain, Acute Pain 4 (2002) 77.
Stephan A. Schug Anaesthesia and Pain Medicine University of Western Australia and Royal Perth Hospital, Perth, WA 6847, Australia Tel.: +61-8-9224-0201; fax: +61-8-9224-0279 E-mail address: [email protected] (S.A. Schug)
1366-0071/02/$ – see front matter © 2002 Elsevier Science B.V. All rights reserved. PII: S 1 3 6 6 - 0 0 7 1 ( 0 2 ) 0 0 0 2 8 - 1