In other words, it is a simple bedside test, conducted in two parts. The primary purpose of this test is to assess whether the pain experienced is predominantly due to nerve damage or not. The LANSS scale is the only published tool with validity for discriminating between neuropathic and nociceptive pain, regardless if the disease-based diagnostic methods. However, it important to note that the purpose of this test is to assist the clinicians in assessing the severity of the pain or its causes. According to various research reports, these LANSS tests correctly classified the patients as suffering from nociceptive and neuropathic pain, in four out of every five patients experiencing chronic pain. Would you describe your pain as strange unpleasant sensations in your skin?
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It comprises of a 7 item questionnaire that aims to discern which nerves involved with carrying pain signals have been impaired and which are properly functioning. The first five questions address pain sensations that the patient has been experiencing during the past week. The evaluator asks about different characteristics of the pain and the patient needs to confirm or infirm each of them.
Is the skin appearance mottled, red or pinkish? For instance, the patient is asked whether they experience electric shocks, jumping or bursting sensations in the painful areas or limbs. The second part of the LANSS score is composed of two physical exams in which pain and skin sensitivity is compared to contralateral or adjacent non painful areas. This is a mean of evaluating the presence of allodynia and that of an altered pin-prick threshold.
Allodynia is defined as the experience of pain from non painful stimulation, usually caused by light touch. The exam is positive if the non painful area has a normal response while pain is experienced in the painful area.
The response is then compared. Usually, for a positive test, in the non painful area the patient feels a sharp pin prick but in the painful areas either no response or a blunt one is experienced characteristic for raised PPT or a very painful sensation lowered PPT. Discerning the type of pain is essential in establishing the right pain management treatment and the scale can also be used to monitor pain response in time.
Neuropathic pain guidelines This is a type of chronic pain in which the nerve fibers are damaged or injured or there are certain mechanisms that have rendered them dysfunctional. The impaired nerves send incorrect pain signals in different areas of the body. The most common causes include different types of injuries, amputation, multiple sclerosis, back problems, chemotherapy or diabetes.
Symptoms experienced are different types of pain in varying degrees. Diagnostics are usually put after a physical and sensory exam as well as blood tests and other specific laboratory tests depending on the area of pain and suspected cause.
Treatment management comprises of non steroidal anti inflammatory drugs up until strong painkillers like opioids. Pain specialists also recommend electrical stimulation therapies, massage therapy or acupuncture, techniques that are proved to have some alleviating effects. Score interpretation The bed side questionnaire focuses on the neuropathic mechanisms behind pain while translating medical information into easily understandable clues for the patients to describe their status.
The scoring system is simple with each of the 7 items being awarded a weighted number of points. Only the positive answers are given points while the negative answers are classed as naught.
Scores range from 0 to 24, with scores below 12 carrying a lower chance of pain being caused by neuropathic mechanisms while scores above 12 are most likely characterizing neuropathic pain.
The original study focused on 60 chronic pain patients with nociceptive and neuropathic pain The subsequent validation focuses on the discriminating capabilities of the scale on 40 patients. There are also a modified version and a self report scale available for sensory examinations.
The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs.
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)