Rolf-Detlef Treede &
Troels Staehelin Jensen talk with ScienceWatch.com
and answer a few questions about this month's New Hot Paper
in the field of Neuroscience &
Article Title: Neuropathic pain - Redefinition and
a grading system for clinical and research
RD;Jensen, TS;Campbell, JN;Cruccu, G;Dostrovsky,
JO;Griffin, JW;Hansson, P;Hughes, R;Nurmikko, T;Serra,
Year: APR 29 2008
* Aarhus Univ Hosp, Dept Neurol, Norrebrogade 44, DK-8000
Aarhus C, Denmark.
* Aarhus Univ Hosp, Dept Neurol, DK-8000 Aarhus C,
* Johannes Gutenberg Univ Mainz, Inst Physiol &
Pathophysiol, D-6500 Mainz, Germany.
(addresses have been truncated)
Why do you think your paper is highly
Within the field of pain research, neuropathic pain is one of the most
active research areas both in the basic and clinical sciences. We address
the definition of the phenomenon "neuropathic pain" itself and provide a
grading scheme based on positive identification criteria.
Whereas there is little doubt on the neuropathic nature of, e.g., painful
diabetic neuropathy, this is less clear for different types of pain in
multiple sclerosis, and highly controversial for the diffuse pain of
fibromyalgia. Our paper describes a framework—definition and grading
system—for reporting primary data on patients with possible,
probable, or definite neuropathic pain.
Does it describe a new discovery, methodology, or
synthesis of knowledge?
Troels Staehelin Jensen
Our paper describes a method—grading system—based on a
synthesis of knowledge. The 1994 definition of neuropathic pain published
by the International Association for the Study of Pain (IASP
Press®) had been criticized by several neurologists as being
We focused the definition by spelling out that neuropathic pain is a
condition due to damage to the somatosensory system. The grading system is
based on lines of evidence for the location and nature of that damage.
Would you summarize the significance of your paper
in layman's terms?
Neuropathic pain results from damage to the warning system of the body that
normally signals impending injury to organs or tissues. Patients with
neuropathic pain typically exhibit a mixture of sensory loss—reduced
responsiveness to external stimuli—with ongoing spontaneous pain and
sometimes enhanced sensitivity to externally applied painful stimuli
Our paper describes a refined definition for this type of pain together
with a grading system. The grading system allows clinicians to communicate
the level of evidence that they have obtained for a single patient on the
neuropathic nature of the patient's pain complaint. Since treatment of
neuropathic pain differs from that of other types of pain, better precision
in diagnosis is expected to lead to a faster initiation of the appropriate
How did you become involved in this research, and
were there any problems along the way?
This consensus process was initiated by Prof. Troels Jensen, and included
the expertise of pain societies (IASP and its special interest group
NeuPSIG) and neurological societies such as the European Federation of
Neurological Societies (EFNS) and the American Academy of Neurology (AAN).
As in any consensus process there was a heated scientific debate among
coauthors on several aspects of our paper, which took a few years to
resolve. We appreciate that this debate continued with the reviewers after
submission of the manuscript, leading to further improvement in the
phrasing of our statements.
Where do you see your research leading in the
We anticipate better communication among researchers and among clinicians,
when they use the proposed grading scheme to indicate the level of
certainty that the pain state they describe is neuropathic in nature. We
hope to see many empirical studies using the grading system, so it can be
revised on an evidence-based level in a few years' time.
Do you foresee any social or political implications
for your research?
Yes, absolutely. If this proposal succeeds, neuropathic pain will
ultimately be integrated into the nosology of neurological conditions, as
headache already has. This should lead to more precise diagnosis of the
neuropathic nature of a pain complaint, which in turn should guide a
mechanism-based approach to pain therapy.
Prof. Dr. med. Rolf-Detlef Treede
Lehrstuhl für Neurophysiologie
Medizinische Fakultät Mannheim
Mannheim, Germany Web
Prof. Troels Staehelin Jensen, M.D., Ph.D.
Danish Pain Research Center
Aarhus University Hospital
Aarhus, Denmark Web