The Epidemiology of Chronic Pain of Predominantly Neuropathic Origin. Results From a General Population Survey

Published:January 23, 2006DOI:


      Progress in the understanding of chronic pain with neuropathic features has been hindered by a lack of epidemiologic research in the general population. The Leeds Assessment of Neuropathic Symptoms and Signs score (S-LANSS) was recently validated for use in postal surveys, making the identification of pain of predominantly neuropathic origin possible. Six family practices in 3 UK cities (Aberdeen, Leeds, and London) generated a total random sample of 6,000 adults. The mailed questionnaire included demographic items, chronic pain identification, and intensity questions, the S-LANSS, the Level of Expressed Needs questionnaire, and the Neuropathic Pain Scale. With a corrected response rate of 52%, the prevalence of any chronic pain was 48% and the prevalence of pain of predominantly neuropathic origin was 8%. Respondents with this chronic neuropathic pain were significantly more likely to be female, slightly older, no longer married, living in council rented accommodation, unable to work, have no educational qualifications, and be smokers than all other respondents. Multiple logistic regression modeling found that pain of predominantly neuropathic origin was independently associated with older age, gender, employment (being unable to work), and lower educational attainment. Respondents with this pain type also reported significantly greater pain intensity, higher scores on the NPS, higher levels of expressed need, and longer duration of pain. This is the first estimate of the prevalence and distribution of pain of predominantly neuropathic origin in the general population, using a previously validated and reliable data collection instrument.


      Chronic pain with neuropathic features appears to be more common in the general population than previously suggested. This type of pain is more severe than other chronic pain but distributed similarly throughout sociodemographic groups.

      Key words

      To read this article in full you will need to make a payment
      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Attal N.
        • Bouhassira D.
        Can pain be more or less neuropathic?.
        Pain. 2004; 110: 510-511
        • Bennett M.
        The LANSS Pain Scale.
        Pain. 2001; 92: 147-157
        • Bennett M.I.
        • Smith B.H.
        • Torrance N.
        • Potter J.
        The S-LANSS score for identifying pain of predominantly neuropathic origin.
        J Pain. 2005; 6: 149-158
        • Biener L.
        • Garrett C.A.
        • Gilpin E.A.
        • Roman A.M.
        • Currivan D.B.
        Consequences of declining survey respone rates for smoking prevalence estimates.
        Am J Prev Med. 2004; 27: 254-257
        • Blyth F.M.
        • March L.M.
        • Brnabic A.J.M.
        • Jorm L.R.
        • Williamson M.
        • Cousins M.J.
        Chronic pain in Australia.
        Pain. 2001; 89: 127-134
        • Bonica J.J.
        in: Nashold B.S. Ovelman-Levitt J. Deafferentation Pain Syndromes Pathophysiology and Treatment. Raven Press, New York1991: 1-19
        • Bouhassira D.
        • Attal N.
        • Fermanian J.
        • Alchaar H.
        • Gautron M.
        • Masquelier E.
        • Rostaing S.
        • Lanteri-Minet M.
        • Collin E.
        • Grisart J.
        • Biureau F.
        Development and validation of the Neuropathic Pain Symptom Inventory.
        Pain. 2004; 108: 248-257
        • Bowsher D.
        Neurogenic pain syndromes and their management.
        Br Med Bull. 1991; 47: 644-666
        • Caraceni A.
        • Portenoy R.K.
        • IASP Task Force on Cancer Pain
        An international survey of cancer pain characteristics and syndromes.
        Pain. 1999; 82: 263-274
        • Cherny N.I.
        • Thaler H.T.
        • Friedlander-Klar H.
        • Lapin J.
        • Foley K.M.
        • Houde R.
        • Portenoy R.K.
        Opioid responsiveness of cancer pain syndromes caused by neuropathic or nociceptive mechanisms.
        Neurology. 1994; 44: 857-861
        • Davies H.T.
        • Crombie I.K.
        • Macrae W.A.
        • Rogers K.M.
        Pain clinic patients in northern Britain.
        Pain Clinic. 1992; 5: 129-135
        • Dworkin R.H.
        • Backonja M.
        • Rowbotham M.C.
        • Allen R.R.
        • Argoff C.R.
        • Bennett G.J.
        Advances in neuropathic pain.
        Arch Neurol. 2003; 60: 1524-1534
        • Elliott A.M.
        • Smith B.H.
        • Penny KI Chambers W.A.
        • Smith W.C.
        The epidemiology of chronic pain in the community.
        Lancet. 1999; 354: 1248-1252
        • Elliott A.M.
        • Smith B.H.
        • Hannaford P.C.
        • Smith W.C.
        • Chambers W.A.
        The course of chronic pain in the community.
        Pain. 2002; 99: 299-307
        • Galer B.S.
        • Jensen M.P.
        Development and preliminary validation of a pain measure specific to neuropathic pain. The neuropathic pain scale.
        Neurology. 1997; 48: 332-338
        • Galer B.S.
        • Jensen M.P.
        • Ma T.
        • Davies P.S.
        • Rowbotham M.C.
        The lidocaine patch 5% effectively treats all neuropathic pain qualities.
        Clin J Pain. 2002; 18: 297-310
        • Grond S.
        • Radbruch L.
        • Meuser T.
        • Sabatowski R.
        • Georg Loick
        Pain. 1999; 79: 15-20
        • International Association for the Study of Pain
        Classification of chronic pain.
        Pain Suppl. 1986; 3: S1-S225
        • Lacey R.J.
        • Lewis M.
        • Sim J.
        Presentation of pain drawings in questionnaire survey.
        Pain. 2003; 105: 293-301
        • McQuay H.J.
        Neuropathic pain.
        Eur J Pain. 2002; 6: 11-18
        • Mercadante S.
        • Fulfaro F.
        • Casuccio A.
        • Barresi L.
        Investigation of an opioid response categorization in advanced cancer patients.
        J Pain Symptom Manage. 1999; 18: 347-352
        • Mercadante S.
        • Casuccio A.
        • Puma S.
        • Fulfaro F.
        Factors influencing the opioid response in advanced cancer patients with pain followed at home.
        Support Care Cancer. 2000; 8: 123-130
        • Raja S.N.
        • Haythornwaite J.A.
        • Pappagallo M.
        • Clark M.R.
        • Travison T.G.
        • Sabeen S.
        • Royall R.M.
        • Max M.B.
        Opioids versus antidepressants in postherpetic neuralgia.
        Neurology. 2002; 59: 1015-1021
        • Rowbotham M.C.
        • Harden N.
        • Stacey B.
        • Bernstein P.
        • Magnus-Miller L.
        Gabapentin for the treatment of post-herpetic neuralgia.
        J Am Med Assoc. 1998; 280: 1837-1842
        • Schmader K.E.
        Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy.
        Clin J Pain. 2002; 18: 350-354
        • Smith B.H.
        • Penny K.I.
        • Elliott A.M.
        • Chambers W.A.
        • Smith W.C.S.
        The Level of Expressed Need—a measure of help-seeking behaviour for chronic pain in the community.
        Eur J Pain. 2001; 5: 257-266
        • Smith B.H.
        • Hannaford P.C.
        • Elliott A.M.
        • Smith W.C.S.
        • Chambers W.A.
        The “number needed to sample” in primary care research. Comparison of two primary care sampling frames for chronic back pain.
        Fam Pract. 2005; 22: 205-214
        • Stoate H.G.
        Can health screening damage your health?.
        J R Coll Gen Pract. 1989; 39: 183-195
        • Verhaak P.F.M.
        • Kerssens J.J.
        • Dekker J.
        • Sorbi M.J.
        • Bensing J.M.
        Prevalence of chronic benign pain disorder among adults.
        Pain. 1998; 77: 231-239
        • Von Korff M.
        Epidemiologic and survey methods.
        in: Turk D.C. Melzack R. Handbook of Pain Assessment. 2nd ed. Guilford Press, New York, NY2001: 603-618
        • Watson C.P.
        • Moulin D.
        • Watt-Watson J.
        • Gordon A.
        • Eisenhoffer J.
        Controlled release oxycodone relieves neuropathic pain.
        Pain. 2003; 105: 71-78