Highlights
- •The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks and the American Pain Society Pain Taxonomy chronic central neuropathic pain taxonomy involves spinal cord injury, stroke, and multiple sclerosis.
- •Spinal cord injury-related central pain occurs in 40 to 50% and is located at or below the lesion.
- •Stroke-related central pain occurs in 3 to 8% and is located in areas of the hemibody.
- •Multiple sclerosis-related central pain occurs in 25% and is located consistent with the central nervous system injury.
- •Studies are needed to assess the reliability and validity of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks and the American Pain Society Pain Taxonomy criteria.
Abstract
Central neuropathic pain, which is pain caused by a lesion or disease of the central
somatosensory nervous system, is a serious consequence of spinal cord injury, stroke,
multiple sclerosis, and other conditions affecting the central nervous system. A collaborative
effort between the Analgesic, Anesthetic, and Addiction Clinical Trial Translations,
Innovations, Opportunities, and Networks public-private partnership and the American
Pain Society, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations,
Innovations, Opportunities, and Networks-American Pain Society Pain Taxonomy (AAPT)
initiative, invited a working group to develop diagnostic criteria for central neuropathic
pain. The criteria for central neuropathic pain that were developed expand upon existing
criteria for neuropathic pain and the International Classification of Diseases 11th
Revision draft criteria to ensure consistency. This article focuses on central neuropathic
pain associated with spinal cord injury, stroke, and multiple sclerosis, but the AAPT
framework can be extended to central pain due to other causes such as traumatic brain
injury. The classification of central neuropathic pain is organized according to the
AAPT multidimensional framework, specifically: 1) core diagnostic criteria, 2) common
features, 3) common medical and psychiatric comorbidities, 4) neurobiological, psychosocial,
and functional consequences, and 5) putative neurobiological and psychosocial mechanisms,
risk factors, and protective factors.
Perspective
The AAPT chronic central neuropathic pain taxonomy provides a classification for central
pain associated with spinal cord injury, stroke, and multiple sclerosis. The diagnostic
criteria are organized according to the AAPT multidimensional framework, specifically:
1) core diagnostic criteria, 2) common features, 3) common medical and psychiatric
comorbidities, 4) neurobiological, psychosocial, and functional consequences, and
5) putative neurobiological and psychosocial mechanisms, risk factors, and protective
factors.
Key words
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References
- Incidence of central post-stroke pain.Pain. 1995; 61: 187-193
- Pain, spasticity and quality of life in individuals with traumatic spinal cord injury in Denmark.Spinal Cord. 2016; 54: 973-979
- The LANSS Pain Scale: The Leeds Assessment of Neuropathic Symptoms and Signs.Pain. 2001; 92: 147-157
- What is spontaneous pain and who has it?.J Pain. 2012; 13: 921-929
- Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).Pain. 2005; 114: 29-36
- Central pain: Clinical and physiological characteristics.J Neurol Neurosurg Psychiatry. 1996; 61: 62-69
- Approaches to demonstrating the reliability and validity of core diagnostic criteria for chronic pain.J Pain. 2016; 17: T118-T131
- International Spinal Cord Injury Pain (ISCIP) classification: Part 2. Initial validation using vignettes.Spinal Cord. 2012; 50: 404-412
- International Spinal Cord Injury Pain (ISCIP) classification: Part I. Background and description.Spinal Cord. 2012; 50: 413-417
- Screening for neuropathic pain after spinal cord injury with the Spinal Cord Injury Pain Instrument (SCIPI): A preliminary validation study.Spinal Cord. 2014; 52: 407-412
- Neuropathic pain prevalence following spinal cord injury: A systematic review and meta-analysis.Eur J Pain. 2017; 21: 29-44
- Phenomenological study of neurogenic bowel from the perspective of individuals living with spinal cord injury.Arch Phys Med Rehabil. 2015; 96: 49-55
- Classification of chronic pain associated with spinal cord injuries.Arch Phys Med Rehabil. 2002; 83: 1708-1714
- Symptomatic and palliative care for stroke survivors.J Gen Intern Med. 2012; 27: 853-860
- Trigeminal neuralgia: New classification and diagnostic grading for practice and research.Neurology. 2016; 87: 220-228
- Decreased spinothalamic and dorsal column medial lemniscus-mediated function is associated with neuropathic pain after spinal cord injury.J Neurotrauma. 2012; 29: 2706-2715
- An empirical investigation of a biopsychosocial model of pain in multiple sclerosis.Clin J Pain. 2016; 32: 155-163
- Quantitative somatosensory testing of subjects with chronic post-traumatic headache: Implications on its mechanisms.Eur J Pain. 2010; 14: 924-931
- Central poststroke pain: Somatosensory abnormalities and the presence of associated myofascial pain syndrome.BMC Neurol. 2012; 12: 89
- Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis.Arch Phys Med Rehabil. 2008; 89: 1923-1932
- Multidimensional diagnostic criteria for chronic pain: Introduction to the ACTTION-American Pain Society Pain Taxonomy (AAPT).J Pain. 2016; 17: T1-T9
- The role of psychosocial processes in the development and maintenance of chronic pain.J Pain. 2016; 17: T70-T92
- The ACTTION-American Pain Society Pain Taxonomy (AAPT): An evidence-based and multidimensional approach to classifying chronic pain conditions.J Pain. 2014; 15: 241-249
- Assessment of chronic pain: Domains, methods, and mechanisms.J Pain. 2016; 17: T10-T20
- Spinal cord injury pain: Mechanisms and management.Curr Pain Headache Rep. 2012; 16: 207-216
- Abdominal pain in long-term spinal cord injury.Spinal Cord. 2008; 46: 198-203
- Neuropathic pain: An updated grading system for research and clinical practice.Pain. 2016; 157: 1599-1606
- A prospective study of pain and psychological functioning following traumatic spinal cord injury.Spinal Cord. 2016; 51: 816-821
- Phenotypes and predictors of pain following traumatic spinal cord injury: A prospective study.J Pain. 2014; 15: 40-48
- Neuropathic pain needs systematic classification.Eur J Pain. 2013; 17: 953-956
- Segmental hypersensitivity and spinothalamic function in spinal cord injury pain.Exp Neurol. 2007; 207: 139-149
- Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs.Pain. 2014; 155: 367-376
- painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain.Curr Med Res Opin. 2006; 22: 1911-1920
- Thalamic activity and biochemical changes in individuals with neuropathic pain after spinal cord injury.Pain. 2014; 155: 1027-1036
- Remote astrocytic and microglial activation modulate neuronal hyperexcitability and below-level neuropathic pain after spinal injury in rat.Neuroscience. 2009; 161: 895-903
- NeuPSIG guidelines on neuropathic pain assessment.Pain. 2011; 152: 14-27
- Activated microglia contribute to the maintenance of chronic pain after spinal cord injury.J Neurosci. 2006; 26: 4308-4317
- Screening tools for neuropathic pain: Can they be of use in individuals with spinal cord injury?.Pain. 2011; 152: 772-779
- Pain following stroke: A prospective study.Eur J Pain. 2012; 16: 1128-1136
- Central poststroke pain in young ischemic stroke survivors in the Helsinki Young Stroke Registry.Neurology. 2014; 83: 1147-1154
- The prevalence of central poststroke pain according to the integrity of the spino-thalamo-cortical pathway.Eur Neurol. 2012; 67: 12-17
- A new definition of neuropathic pain.Pain. 2011; 152: 2204-2205
- Bodily pain, social support, depression symptoms and stroke history are independently associated with sleep disturbance among the elderly: A cross-sectional analysis of the Fujiwara-kyo study.Environ Health Prev Med. 2016; 21: 295-303
- Central poststroke pain: A population-based study.Pain. 2011; 152: 818-824
- Central post-stroke pain: Clinical characteristics, pathophysiology, and management.Lancet Neurol. 2009; 8: 857-868
- Early evoked pain or dysesthesia is a predictor of central poststroke pain.Pain. 2014; 155: 2699-2706
- Development of a neuropathic pain questionnaire.Clin J Pain. 2003; 19: 306-314
- Central post-stroke pain–neurological symptoms and pain characteristics.Pain. 1989; 36: 13-25
- Central poststroke pain and Wallenberg lateral medullary infarction: Frequency, character, and determinants in 63 patients.Neurology. 1997; 49: 120-125
- Overlapping chronic pain conditions: Implications for diagnosis and classification.J Pain. 2016; 17: T93-T107
- Lifetime and actual prevalence of pain and headache in multiple sclerosis.Mult Scler. 2008; 14: 514-521
- The CanPain SCI Clinical Practice Guidelines for rehabilitation management of neuropathic pain after spinal cord: Screening and diagnosis recommendations.Spinal Cord. 2016; 54: S7-S13
MS International Federation: Atlas of MS. Available at: https://www.msif.org/about-us/advocacy/atlas Accessed May 29, 2017
National Spinal Cord Injury Statistical Center. Available at: https://www.nscisc.uab.edu/ Accessed May 29, 2017
- Chronic abdominal pain in long-term spinal cord injury: A follow-up study.Spinal Cord. 2017; 55: 290-293
- Multiple sclerosis-related central pain disorders.Curr Pain Headache Rep. 2010; 14: 189-195
- Psychosocial factors associated with pain intensity, pain-related interference, and psychological functioning in persons with multiple sclerosis and pain.Pain. 2007; 127: 52-62
Österberg A, Boivie J: Central pain in multiple sclerosis - sensory abnormalities, in Central Pain in multiple sclerosis – clinical characteristics, sensory abnormalities, and treatment, A. Österberg, ed. Thesis, Linköpings Universitet, 2005
- Central pain in multiple sclerosis–prevalence and clinical characteristics.Eur J Pain. 2005; 9: 531-542
- Pain associated with multiple sclerosis: Systematic review and proposed classification.Pain. 2008; 137: 96-111
- Chronic pain syndromes after ischemic stroke: PRoFESS trial.Stroke. 2013; 44: 1238-1243
- Proton magnetic resonance spectroscopy of the thalamus in patients with chronic neuropathic pain after spinal cord injury.AJNR Am J Neuroradiol. 2002; 23: 901-905
- Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.Ann Neurol. 2011; 69: 292-302
- Need for symptomatic management in advanced multiple sclerosis.Acta Neurol Scand. 2017; 135: 529-532
- Towards a mechanism-based view on post-stroke shoulder pain: Theoretical considerations and clinical implications.NeuroRehabilitation. 2012; 30: 153-165
- From the person’s perspective: Perceived problems in functioning among individuals with spinal cord injury in Switzerland.J Rehabil Med. 2016; 48: 235-243
- Neurophysiologic study of central pain in patients with Parkinson disease.Neurology. 2007; 69: 2162-2169
- Non-painful sensory phenomena after spinal cord injury.J Neurol Neurosurg Psychiatry. 1999; 66: 617-622
- A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury.Pain. 2003; 103: 249-257
- Sensory function and quality of life in patients with multiple sclerosis and pain.Pain. 2005; 114: 473-481
- Pain in patients with multiple sclerosis: A population-based study.Arch Neurol. 2003; 60: 1089-1094
- Neuropathic pain: Redefinition and a grading system for clinical and research purposes.Neurology. 2008; 70: 1630-1635
- A classification of chronic pain for ICD-11.Pain. 2015; 156: 1003-1007
- A mechanism-based classification of pain in multiple sclerosis.J Neurol. 2013; 260: 351-367
- Mechanisms of pain in multiple sclerosis: A combined clinical and neurophysiological study.Pain. 2012; 153: 2048-2054
- Assessment of psychosocial and functional impact of chronic pain.J Pain. 2016; 17: T21-T49
- Mental health comorbidity in MS: Depression, anxiety, and bipolar disorder.Curr Neurol Neurosci Rep. 2016; 16: 106
- Toward a mechanism-based approach to pain diagnosis.J Pain. 2016; 17: T50-T69
- Sensory abnormalities in consecutive, unselected patients with central post-stroke pain.Pain. 1995; 61: 177-186
- Residual spinothalamic tract pathways predict development of central pain after spinal cord injury.Brain. 2008; 131: 2387-2400
- Relationship between pain characteristics and pain adaptation type in persons with SCI.J Rehabil Res Dev. 2009; 46: 43-56
- Somatosensory phenotype is associated with thalamic metabolites and pain intensity after spinal cord injury.Pain. 2015; 156: 166-174
- Psychosocial profiles of people with pain associated with spinal cord injury: Identification and comparison with other chronic pain syndromes.Clin J Pain. 2004; 20: 261-271
- Multidimensional neuropathic pain phenotypes after spinal cord injury.J Neurotrauma. 2016; 33: 482-492
- Psychosocial subgroups in persons with spinal cord injuries and chronic pain.Arch Phys Med Rehabil. 2007; 88: 1628-1635
- Subacute pain after traumatic brain injury is associated with lower insular N-acetylaspartate concentrations.J Neurotrauma. 2016; 33: 1380-1389
- Metabolite concentrations in the anterior cingulate cortex predict high neuropathic pain impact after spinal cord injury.Pain. 2013; 154: 204-212
- Exacerbation of chronic pain following spinal cord injury.J Neurotrauma. 2004; 21: 1384-1395
- Central sensitization: Implications for the diagnosis and treatment of pain.Pain. 2011; 152: S2-S15
World Health Organization: Spinal Cord Injury. Available at: http://www.who.int/mediacentre/factsheets/fs384/en/. Accessed May 29, 2017
- Neuropathic pain and primary somatosensory cortex reorganization following spinal cord injury.Pain. 2009; 141: 52-59
- Heart disease and stroke statistics-2016 update: A report from the American Heart Association.Circulation. 2016; 133: e38-e360
- Cortical and white matter alterations in patients with neuropathic pain after spinal cord injury.Brain Res. 2013; 1540: 64-73
- The nature and course of sensory changes following spinal cord injury: Predictive properties and implications on the mechanism of central pain.Brain. 2012; 135: 418-430
- Hemiplegic shoulder pain: Evidence of a neuropathic origin.Pain. 2013; 154: 263-271
- SOCS1 regulates neuropathic pain by inhibiting neuronal sensitization and glial activation in mouse spinal cord.Brain Res Bull. 2016; 124: 237
- Extracellular signal-regulated kinase-regulated microglia-neuron signaling by prostaglandin E2 contributes to pain after spinal cord injury.J Neurosci. 2007; 27: 2357-2368
- Modulation of thalamic nociceptive processing after spinal cord injury through remote activation of thalamic microglia by cysteine cysteine chemokine ligand 21.J Neurosci. 2007; 27: 8893-8902
- Improving quality of life in multiple sclerosis: An unmet need.Am J Manag Care. 2011; 17: S139-S145
Article info
Publication history
Published online: June 27, 2017
Footnotes
The views expressed in this article are those of the authors, none of whom has financial conflicts of interest relevant to the issues discussed in this report. No official endorsement by the US Food and Drug Administration (FDA) should be inferred. Support was provided by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the FDA, which has received contracts, grants, and other revenue for its activities from the FDA, multiple pharmaceutical and device companies, and other sources. A complete list of current Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks sponsors is available at: http://www.acttion.org/partners.
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© 2017 by the American Pain Society
