Central / peripheral neuropathic pain

Rationale

Neuropathic pain is a common and often disabling symptom with many underlying causes. It may be the initial presentation of a potentially serious underlying medical condition. Various treatment options exist. If not diagnosed and treated early, it may result in greater disability.

Causal Conditions

(list not exhaustive)

1. Metabolic (e.g., diabetic neuropathy)
2. Nerve entrapment (e.g., carpal tunnel syndrome, lymphoma, trigeminal neuralgia)
3. Infectious (e.g., postherpetic neuralgia)
4. Central (e.g., phantom limb pain, spinal cord injuries)
5. Sympathetic (e.g., reflex sympathetic dystrophy)

Key Objectives

Given a patient with neuropathic pain, the candidate will diagnose the cause, severity, and complications and will initiate an appropriate management plan.

Enabling Objectives

Given a patient with neuropathic pain, the candidate will

1. list and interpret critical clinical findings derived from a thorough history and physical examination, including
   1. a thorough review of the pain history (including past treatments) and psychosocial and functional impairment; and
   2. the identification of signs of neurologic impairment and other causes of pain or numbness (e.g., vascular insufficiency);
2. list and interpret possible appropriate investigations, including
   1. screening investigations for underlying medical conditions (e.g., fasting glucose level, chest radiography);
   2. nerve conduction studies; and
   3. vascular studies; and
3. construct an effective initial management plan, including
   1. discussing possible pharmacotherapeutic options;
   2. counselling, including prevention of progression (e.g., chronicity of symptoms, exercise, activity modification);
   3. providing optimal treatment of any underlying medical conditions (e.g., diabetes management); and
   4. determining whether the patient needs a referral to a pain clinic or pain specialist.