Fishbain David A, Lewis John E, Cutler Robert, Cole Brandly, Rosomoff Hubert L, Rosomoff Rennée S
Department of Psychiatry, University of Miami, Miami, Florida, USA.
Pain Med. 2008 Mar;9(2):149-60. doi: 10.1111/j.1526-4637.2007.00302.x.
A total of 305 CPPs consecutive admissions to The Rosomoff Pain Center were administered the NPS and were assigned a diagnosis according to the physical examination and all available test results. CPPs with a diagnosis of chronic radiculopathy and spondylolysis/degenerative arthritis were segregated into two groups for the purposes of having a group representative of neuropathic pain (chronic radiculopathy) and non-neuropathic pain (spondylolysis/degenerative arthritis). Applying neuropathic pain criteria to each "of these two groups": a neuropathic pain "subtype" was identified within the chronic radiculopathy group; and, a non-neuropathic pain "subtype" was identified within the spondylolysis/degenerative arthritis group. This step was performed in order to assure that the CPPs selected for further analysis were truly representative of neuropathic and non-neuropathic pain. Discriminant function analysis was then employed to determine if NPS scoring could differentiate between these two "subtypes." Results from the discriminant function analysis model were utilized to derive an NPS cut-off score above which CPPs would be classified as having neuropathic pain. For the diagnoses of myofascial pain syndromes, spinal stenosis, epidural fibrosis, fibromyalgia, complex regional pain syndromes 1 and 2, and failed back surgery syndrome, a predicted NPS score was calculated and compared with the cut-off score.
Multidisciplinary pain facility.
Chronic pain patients.
The NPS appeared to be able to separate CPPs into neuropathic pain vs non-neuropathic pain subtypes. The derived cut-off score from the model was 5.53. Myofascial pain syndrome and spinal stenosis had predictive scores lower than this cut-off score at 3.81 and 4.26, respectively. Epidural fibrosis, fibromyalgia, complex regional pain syndromes 1 and 2, and failed back surgery syndrome had predictive scores higher than the cut-off score at 6.15, 6.35, 6.87, 9.34, and 7.19, respectively.
The NPS appears to be able to discriminate between neuropathic and non-neuropathic pain. A debate is currently raging as to whether diagnoses, such as fibromyalgia and complex regional pain syndrome 1, can be classified as neuropathic. Our NPS cut-off score results suggest that these diagnoses may have a neuropathic pain component. The reliability and validity of our NPS method will need to be tested further in other neuropathic pain models, such as diabetic peripheral neuropathic pain.
1）确定神经病理性疼痛量表（NPS）是否可用于将慢性疼痛患者（CPPs）分类为主要患有神经病理性疼痛与非神经病理性疼痛，此外；2）确定可用于可靠做出此判定的临界分数（若有）。
连续收治入罗索莫夫疼痛中心的305例CPPs接受了NPS评估，并根据体格检查和所有可用检测结果进行诊断。为了有一组代表神经病理性疼痛（慢性神经根病）和非神经病理性疼痛（椎弓根峡部裂/退行性关节炎）的患者，将诊断为慢性神经根病和椎弓根峡部裂/退行性关节炎的CPPs分为两组。将神经病理性疼痛标准应用于这两组中的每一组：在慢性神经根病组中确定了一种神经病理性疼痛“亚型”；并且，在椎弓根峡部裂/退行性关节炎组中确定了一种非神经病理性疼痛“亚型”。执行此步骤是为了确保选择用于进一步分析的CPPs真正代表神经病理性疼痛和非神经病理性疼痛。然后采用判别函数分析来确定NPS评分是否能够区分这两种“亚型”。判别函数分析模型的结果用于得出一个NPS临界分数，高于此分数的CPPs将被分类为患有神经病理性疼痛。对于肌筋膜疼痛综合征、腰椎管狭窄症、硬膜外纤维化、纤维肌痛、复杂性区域疼痛综合征1和2以及腰椎手术失败综合征的诊断，计算预测的NPS评分并与临界分数进行比较。
多学科疼痛治疗机构。
慢性疼痛患者。
NPS似乎能够将CPPs分为神经病理性疼痛与非神经病理性疼痛亚型。模型得出的临界分数为5.53。肌筋膜疼痛综合征和腰椎管狭窄症的预测评分分别低于此临界分数，为3.81和4.26。硬膜外纤维化、纤维肌痛、复杂性区域疼痛综合征1和2以及腰椎手术失败综合征的预测评分分别高于临界分数，为6.15、6.35、6.87、9.34和7.19。
NPS似乎能够区分神经病理性疼痛和非神经病理性疼痛。关于诸如纤维肌痛和复杂性区域疼痛综合征1等诊断是否可归类为神经病理性疼痛，目前正在激烈争论。我们的NPS临界分数结果表明，这些诊断可能具有神经病理性疼痛成分。我们的NPS方法的可靠性和有效性需要在其他神经病理性疼痛模型中进一步测试，例如糖尿病性周围神经病理性疼痛。
