Austin Paul Essay on chronic neuropathic pain（奥斯丁保罗论慢性神经性疼痛）.pdfVIP

Name of Disorder: Chronic neuropathic pain Essay Title: Chronic neuropathic pain: A clinical perspective Author: Dr. Paul Austin (PhD, Masters) Institution: University of Sydney Date: 23/6/14 Introduction Chronic neuropathic pain is not a single entity, but refers to a heterogeneous group of pain conditions that are surprisingly common in clinical practice; with an estimated prevalence of 8-17% in the general population [1, 2]. Specific treatment options for neuropathic pain are severely lacking, with less than half of patients receiving adequate pain relief. Furthermore, neuropathic pain greatly impairs quality of life and is a major economical problem, costing the Australian economy in the region of $5 billion per year, due to loss of working days and healthcare costs [3, 4]. Clinical definition and causes The current definition for chronic neuropathic pain from the International Association for the Study of Pain is “Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system” [5]. Where the term ‘disease’ refers to the presence of an identifiable pathological process, while ‘lesion’ refers to macro- or microscopically identifiable damage, and ‘somatosensory system’ refers to the neurons that detect sensory stimuli from the skin and internal organs. The definition of ‘chronic’ tends to be determined by an arbitrary length of time since onset, the most common are 3 or 6 months. However, a better description is perhaps pain lasting longer than the expected period of recovery. Neuropathic pain should be further quantified as being of peripheral or central origin in terms of the location of the lesion or disease, as they have distinct clinical manifestation and underlying pathophysiology. As such there are four broad classes of neuropathic pain according to underlying etiology and anatomical location; (i) Painful peripheral neuropathies, again sub-divided into; Focal or multifocal,