The Diagnosis and Treatment of Neuropathic Pain

[Nerve compression syndromes of the median and radial nerves at the elbow]

Nerve compression syndromes of the median and radial nerves at the elbow are usually caused by a combination of traction and pressure and are mainly characterized by loss of strength and dull, localized elbow pain. Muscular functional impairments can occur, whereas sensory impairments are less common. The diagnostics including a detailed medical history, neurological examination with, for example, lateral comparison muscle testing and imaging procedures such as X‑ray, sonography or magnetic resonance imaging (MRI) are essential. In the early stages, conservative treatment with immobilization and infiltrative cortisone treatment can be successful. If symptoms persist or progress, surgical interventions using magnifying glasses (from 2.5×) and microsurgical instruments or a microscope are indicated. It is particularly important to protect the vascular supply and the nerve gliding tissue in order to ensure optimal regeneration and thus function. With timely diagnostics and treatment the prognosis is good.

A neuropathic pain scale is effective in identifying neuropathic pain

OBJECTIVE

To explore the application value of a Neuropathic Pain Questionnaire (NPQ) in screening for neuropathic pain (NP).

METHODS

Using a prospective study approach, patients with chronic pain treated and hospitalized in Quanzhou First Hospital between September 2020 and December 2023 were chosen as study subjects. Participants were screened using NPQ and then divided into a neuropathic pain group (NP group) and a non-neuropathic pain group (NNP group) based on NPQ's results. The baseline demographic data and disease causes were evaluated using Cronbach's alpha coefficient and Guttman split-half coefficient to assess internal consistency. A receiver operating characteristic (ROC) curve was plotted, and the area under curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed.

RESULTS

A total of of 121 patients were included, with 61 cases in the NP group and 60 cases in NNP group. There were no substantial differences between the NP group and the NNP group in terms of age, gender, education level, payment method of medical treatment, pain duration, average pain duration, or level of pain (all P > 0.05). The NP group had a substantially higher NPQ score (8.67±1.21) than the NNP group (6.31±1.34) (P < 0.05). The primary causes of NP in the NP group were postherpetic neuralgia (26.23%), diabetic neuropathy (21.31%), and central post-stroke pain (18.03%). The NPQ demonstrated strong reliability, with a Cronbach's alpha coefficient of 0.843 and a Guttman split-half coefficient of 0.822. The ROC analysis showed an AUC of 0.907 (95% CI, 0.853-0.961), with a sensitivity of 86.90%, specificity of 78.30%, PPV of 80.30%, and NPV of 85.45%.

CONCLUSION

NPQ is a reliable and effective tool for identifying neuropathic pain. Its high sensitivity and specificity, coupled with strong diagnostic performance, suggest that it can be used as a screening tool for neuropathic pain.

Effect of "normal" versus "mild carpal tunnel syndrome" electrodiagnostic report on surgeon decision and patients clinical outcomes

INTRODUCTION

There exist conflicting electrodiagnostic reports between diagnosing mild carpal tunnel syndrome (CTS) and normal results, depending on the interpretation methods used by electrodiagnosticians. This underscores the necessity for precise clinical guidelines. This study aims to assess how the variation between mild and normal electrophysiological reports impacts (1) subsequent clinical outcomes in patients diagnosed with CTS and (2) physicians' decision-making.

METHODS

In a prospective cohort study, we followed 102 patients with suspected CTS who underwent electrodiagnostic studies (EDX). The EDX results for these patients were categorized as either normal or indicative of mild CTS, based on the interpreter's chosen assessment method, which included median-ulnar palmar mixed comparison or median sensory nerve studies. Patient demographics, EDX reports, the choice between surgical or non-surgical treatment, as well as repeated measurements of post-operative pain and paresthesia, were collected at day 0, two weeks, and 12 weeks post treatment.

RESULTS

The study includes an equal number of patients with mild and normal electrodiagnostic reports, totaling 51 individuals in each group, and revealed no significant differences in their demographic and baseline characteristics. Over time, both groups showed a decrease in symptom severity. Nevertheless, the reduction in pain (P = 0.77 at 12 weeks) and paresthesia (P = 0.32 at 12 weeks) showed no significant differences between the two groups. Furthermore, there were no differences observed between the groups concerning the treatment choices made by the surgeon (P = 0.218).

CONCLUSION

When EDX reports indicate either normal or mild CTS, it seems that this interpretation doesn't substantially influence a surgeon's decision in selecting the treatment option or the resulting clinical outcome post-treatment. This highlights the importance of clinical assessment rather than relying solely on EDX reports in managing these patients.

LEVEL OF EVIDENCE

Level II (Prospective cohort study).