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’, 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I would like to draw attention to the use of the outdated definition of neuropathic pain used within the article: ‘pain resulting from injury to, or dysfunction of, the somatosensory system’. This may have led the reader to conclude that fibromyalgia and CRPS were types of neuropathic pain. This definition was updated by the IASP  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