Abstract：
In these guidelines, we aimed to develop evidence-based recommendations for the use of screening questionnaires and diagnostic tests in patients with neuropathic pain (NeP).
We systematically reviewed studies providing information on the sensitivity and specificity of screening questionnaires, and quantitative sensory testing, neurophysiology, skin biopsy, and corneal confocal microscopy. We also analysed how functional neuroimaging, peripheral nerve blocks, and genetic testing might provide useful information in diagnosing NeP.
Of the screening questionnaires, Douleur Neuropathique en 4 Questions (DN4), I-DN4 (self-administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received a strong recommendation, and S-LANSS (self-administered LANSS) and PainDETECT weak recommendations for their use in the diagnostic pathway for patients with possible NeP. We devised a strong recommendation for the use of skin biopsy and a weak recommendation for quantitative sensory testing and nociceptive evoked potentials in the NeP diagnosis. Trigeminal reflex testing received a strong recommendation in diagnosing secondary trigeminal neuralgia. Although many studies support the usefulness of corneal confocal microscopy in diagnosing peripheral neuropathy, no study specifically investigated the diagnostic accuracy of this technique in patients with NeP. Functional neuroimaging and peripheral nerve blocks are helpful in disclosing pathophysiology and/or predicting outcomes, but current literature does not support their use for diagnosing NeP. Genetic testing may be considered at specialist centres, in selected cases.
These recommendations provide evidence-based clinical practice guidelines for NeP diagnosis. Due to the poor-to-moderate quality of evidence identified by this review, future large-scale, well-designed, multicentre studies assessing the accuracy of diagnostic tests for NeP are needed.
We systematically reviewed studies providing information on the sensitivity and specificity of screening questionnaires, and quantitative sensory testing, neurophysiology, skin biopsy, and corneal confocal microscopy. We also analysed how functional neuroimaging, peripheral nerve blocks, and genetic testing might provide useful information in diagnosing NeP.
Of the screening questionnaires, Douleur Neuropathique en 4 Questions (DN4), I-DN4 (self-administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received a strong recommendation, and S-LANSS (self-administered LANSS) and PainDETECT weak recommendations for their use in the diagnostic pathway for patients with possible NeP. We devised a strong recommendation for the use of skin biopsy and a weak recommendation for quantitative sensory testing and nociceptive evoked potentials in the NeP diagnosis. Trigeminal reflex testing received a strong recommendation in diagnosing secondary trigeminal neuralgia. Although many studies support the usefulness of corneal confocal microscopy in diagnosing peripheral neuropathy, no study specifically investigated the diagnostic accuracy of this technique in patients with NeP. Functional neuroimaging and peripheral nerve blocks are helpful in disclosing pathophysiology and/or predicting outcomes, but current literature does not support their use for diagnosing NeP. Genetic testing may be considered at specialist centres, in selected cases.
These recommendations provide evidence-based clinical practice guidelines for NeP diagnosis. Due to the poor-to-moderate quality of evidence identified by this review, future large-scale, well-designed, multicentre studies assessing the accuracy of diagnostic tests for NeP are needed.
摘要：
目的：在本指南中，我们旨在为神经性疼痛(NeP)患者使用筛查问卷和诊断试验制定循证建议.
方法：我们系统回顾了提供筛查问卷敏感性和特异性信息的研究，和定量感官测试，神经生理学，皮肤活检,和角膜共聚焦显微镜。我们还分析了功能性神经成像，周围神经阻滞,基因检测可能为诊断NeP提供有用的信息。
结果：在筛选问卷中，DouleurNeuropathiqueen4Questions(DN4),I-DN4（自我管理的DN4），利兹神经病变症状和体征评估（LANSS）得到了强烈推荐，以及S-LANSS（自行施用的LANSS）和PainDETECT在可能的NeP患者的诊断途径中的应用推荐不足。我们提出了在NeP诊断中使用皮肤活检的强烈推荐和定量感觉测试和伤害性诱发电位的推荐。三叉神经反射测试在诊断继发性三叉神经痛方面得到了强烈推荐。尽管许多研究支持角膜共聚焦显微镜在诊断周围神经病变中的有用性，没有一项研究专门研究这项技术在NeP患者中的诊断准确性.功能性神经成像和周围神经阻滞有助于揭示病理生理学和/或预测结果。但目前的文献不支持它们用于诊断NeP。可以在专家中心考虑进行基因检测，在选定的情况下。
结论：这些建议为NeP诊断提供了循证临床实践指南。由于本综述确定的证据质量差到中等，未来大规模，精心设计,需要评估NeP诊断测试准确性的多中心研究。
方法：我们系统回顾了提供筛查问卷敏感性和特异性信息的研究，和定量感官测试，神经生理学，皮肤活检,和角膜共聚焦显微镜。我们还分析了功能性神经成像，周围神经阻滞,基因检测可能为诊断NeP提供有用的信息。
结果：在筛选问卷中，DouleurNeuropathiqueen4Questions(DN4),I-DN4（自我管理的DN4），利兹神经病变症状和体征评估（LANSS）得到了强烈推荐，以及S-LANSS（自行施用的LANSS）和PainDETECT在可能的NeP患者的诊断途径中的应用推荐不足。我们提出了在NeP诊断中使用皮肤活检的强烈推荐和定量感觉测试和伤害性诱发电位的推荐。三叉神经反射测试在诊断继发性三叉神经痛方面得到了强烈推荐。尽管许多研究支持角膜共聚焦显微镜在诊断周围神经病变中的有用性，没有一项研究专门研究这项技术在NeP患者中的诊断准确性.功能性神经成像和周围神经阻滞有助于揭示病理生理学和/或预测结果。但目前的文献不支持它们用于诊断NeP。可以在专家中心考虑进行基因检测，在选定的情况下。
结论：这些建议为NeP诊断提供了循证临床实践指南。由于本综述确定的证据质量差到中等，未来大规模，精心设计,需要评估NeP诊断测试准确性的多中心研究。
