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Rapid response to:

Clinical Review State of the Art

Neuropathic pain: mechanisms and their clinical implications

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.f7656 (Published 05 February 2014) Cite this as: BMJ 2014;348:f7656

Rapid Response:

Re: Neuropathic pain: mechanisms and their clinical implications

I thank Drs Cohen and Mao for their review article: ‘neuropathic pain: mechanisms and their clinical implications’[1], it demonstrates just how complex the subjects of neuropathic and chronic pain are.

I would like to draw attention to the use of the outdated definition of neuropathic pain used within the article: ‘pain resulting from injury to, or dysfunction of, the somatosensory system’[2]. This may have led the reader to conclude that fibromyalgia and CRPS were types of neuropathic pain. This definition was updated by the IASP [3] in 2012 to ‘pain caused by a lesion or disease of the somatosensory nervous system’. To illustrate the significance of this apparently minor change in taxonomy, Type 1 CRPS is no longer classified as neuropathic pain whereas in the old definition, it may have been. Until clinicians have a clear understanding of what constitutes a diagnosis of neuropathic pain, their ability to use rational treatments in its management will be further limited.

1 Cohen S, Mao J Neuropathic pain: mechanisms and their clinical implications BMJ 2014;348:f7656

2 Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology2008;70:1630-5.

3 Classification of chronic pain Second Edition, IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk, IASP Press, Seattle, ©1994.

Competing interests: No competing interests

11 March 2014
James Andrew
Ananesthetist
Great Western Hospital
Swindon SN3 6BB