Blair Smith is Professor of Primary Care Medicine; Head of Section, General Practice and Community Medical Education; Deputy Head, Centre of Academic Primary Care; General Practitioner, Peterhead Health Centre and Honorary Consultant in Primary Care (NHS Grampian). His Research Interests include genetic epidemiology (including Generation Scotland); chronic pain (including neuropathic pain); primary care epidemiology; medical education; literature and medicine. He is also the Programme Director (Biological Mechanisms) of the Aberdeen Pain Research Collaboration.
Blair summarises what we know about neuropathic pain and the problems encountered with epidemiological research with regards to:
* The estimated prevalence
* Prevalence of neuropathic pain associated with some conditions
* Proportion of those with some of these conditions who have neuropathic pain.
* Prevalence of the population responding positively to some of the screening instruments
* Factors associated with these (risk and impact)
* How to move from this baseline to hold more valuable information.
‘Epidemiology of Neuropathic Pain’:
Epidemiology is an important clinical tool in designing and evaluating management and prevention strategies. Its aims - to identify incidence, prevalence, distribution and determinants - are particularly relevant to neuropathic pain. However, there is a relative lack of accurate information available. This is for several good reasons, including lack of a gold standard case definition, or means of applying any agreed definition in population-based research. In one sense, neuropathic pain describes a symptom or a mechanism, rather than a specific disease. On the other hand, there are sufficient similarities in the effects and response to treatment between different causes of neuropathic pain to make it worthwhile considering it as a distinct condition.
Estimates of prevalence that are based on specific causes of neuropathic pain tend to be lower (1% to 2%) than those that are based on reports of the classic symptoms (6% to 8%). While the former is probably an under-estimate, the latter may be an over-estimate, and further methodological research is still needed. Neuropathic pain of any cause is associated with poor general health, probably more so than non-neuropathic pain of equivalent severity, and is comparable to other severe chronic diseases in this regard. Psychosocial risk factors for neuropathic pain are similar to those for other chronic pain; there are, however, important mechanism-based risk factors that need to be considered, with a view to preventing specific causes of neuropathic pain, including painful diabetic neuropathy and postsurgical pain. The importance of newly proposed risk factors, including genetic factors, is still to be assessed at a population level.
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