Thorough evaluation and an accurate diagnosis of neuropathic pain are essential for effective treatment. The therapeutic approach and choice of medication for neuropathic pain are different from those for other kinds of nociceptive pain. Therefore, this study aimed to present the current evaluation and diagnostic methods for neuropathic pain.Current Concepts: Grading of the certainty of the presence of neuropathic pain according to the results of clinical history, neurological examination, and confirmatory tests improves the diagnosis of neuropathic pain. The Leeds Assessment of Neuropathic Symptoms and Signs, Neuropathic Pain Questionnaire, Douleur Neuropathique en 4 Questions, and PainDETECT are mainly used for neuropathic pain screening. During physical examination, sensory nerve function tests are more critical than other nervous system examination items, including the test of the sense of touch with a cotton swab and the sense of vibration with a tuning fork. In addition, pain sensation using pins and temperature sensation using cold metal are tested to check for nociceptive pathway abnormalities. Diagnostic tests include imaging tests, nerve conduction tests, and other neurophysiological tests, such as quantitative sensory function tests, autonomic nerve function tests, and blood tests.Discussion and Conclusion: To diagnose neuropathic pain, physicians should first determine whether patient symptoms match the characteristics of neuropathic pain. If there is a possibility of neuropathic pain, physicians should perform a neurological screening examination and a proper diagnostic test to identify the cause of pain.

Diabetic neuropathy and chemotherapy-induced peripheral neuropathy are complex disorders affecting different nerve fiber group and remain as major source of morbidity and decreased quality of life of the patients. Given the recent advance in understanding the pathophysiological mechanism of these neuropathies and the development of new drugs, it is imperative to set proper scales to rate the severity of symptoms or signs. Moreover, well-designed, highly sensitive and valid scales could get scientific reliability and clinical utility if they are combined with objective neurophysiological measures. This review will discuss about the reliable and validated scales used in these common toxic and metabolic neuropathies.

Neuropathy is the most prevalent microvascular complication of diabetes mellitus; it encompasses distal symmetric polyneuropathy, autonomic neuropathy, radiculoplexus neuropathy, mononeuropathy, and treatment-induced neuropathy. The prevalence rate of diabetic neuropathy in Korea was reported to be approximately 43%, which is similar to rates in other countries. However, the precise pathogenic mechanism underlying diabetic neuropathy is still obscure, and many clinical trials have failed to develop methods to prevent or reduce the progression of diabetic neuropathy. Nevertheless, early diagnosis and proper management of diabetic neuropathy are essential to alleviate disabling symptoms and to improve the quality of life of patients. This review discusses clinical manifestations and classification of diabetic neuropathies, bedside neurological examination, and electrophysiological tests.

Thorough evaluation and an accurate diagnosis of neuropathic pain are essential for effective treatment. The therapeutic approach and choice of medication for neuropathic pain are different from those for other kinds of nociceptive pain. Therefore, this study aimed to present the current evaluation and diagnostic methods for neuropathic pain.Current Concepts: Grading of the certainty of the presence of neuropathic pain according to the results of clinical history, neurological examination, and confirmatory tests improves the diagnosis of neuropathic pain. The Leeds Assessment of Neuropathic Symptoms and Signs, Neuropathic Pain Questionnaire, Douleur Neuropathique en 4 Questions, and PainDETECT are mainly used for neuropathic pain screening. During physical examination, sensory nerve function tests are more critical than other nervous system examination items, including the test of the sense of touch with a cotton swab and the sense of vibration with a tuning fork. In addition, pain sensation using pins and temperature sensation using cold metal are tested to check for nociceptive pathway abnormalities. Diagnostic tests include imaging tests, nerve conduction tests, and other neurophysiological tests, such as quantitative sensory function tests, autonomic nerve function tests, and blood tests.Discussion and Conclusion: To diagnose neuropathic pain, physicians should first determine whether patient symptoms match the characteristics of neuropathic pain. If there is a possibility of neuropathic pain, physicians should perform a neurological screening examination and a proper diagnostic test to identify the cause of pain.

Diabetic neuropathy and chemotherapy-induced peripheral neuropathy are complex disorders affecting different nerve fiber group and remain as major source of morbidity and decreased quality of life of the patients. Given the recent advance in understanding the pathophysiological mechanism of these neuropathies and the development of new drugs, it is imperative to set proper scales to rate the severity of symptoms or signs. Moreover, well-designed, highly sensitive and valid scales could get scientific reliability and clinical utility if they are combined with objective neurophysiological measures. This review will discuss about the reliable and validated scales used in these common toxic and metabolic neuropathies.

Peripheral neuropathies are common in neurological practice, but it is also tue that they are common in many other medical and surgical fields. There are hundreds and thousands causes of peripheral neuropathies, and a variety of clinical manifestations. Diagnostic approach includes through history taking, neurologic examination focused on the motor and sensory system, serologic investigation with proper electrodiagnostic studies. The first and essential step is to know the clinical characteristics of peripheral neuropathies and caterogorize them to subtype for differential diagnosis. However, up to 30% of the neuropathy remains idiopathic despite of extensive evaluation. Symptomatic management with serial follow up is essential in these cryptogenic neuropathies. Herein, the clinical symptoms and signs of peripheral neuropathy and symptomatic management of neuropathic pain will be briefly reviewed.
Diagnosis, Differential ; Follow-Up Studies ; Neuralgia ; Neurologic Examination ; Peripheral Nervous System Diseases* ; Polyneuropathies

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy caused by compression of the median nerve at the wrist. Although symptoms and signs of CTS are widely known, it is often difficult to make a correct diagnosis. A clinical examination, electrophysiological studies, and ultrasonographic evaluation have similar sensitivities and specificities, and combining them improves diagnostic yield. However, evidence about the optimal treatment has not been well established. We review the clinical manifestations, diagnostic methods, and treatment options for CTS.
Carpal Tunnel Syndrome* ; Diagnosis ; Median Nerve ; Neural Conduction ; Ultrasonography ; Wrist

Acute sensorimotor polyneuropathy that resembles Guillain-Barre syndrome (GBS) is rarely accompanied with nephrotic syndrome, and its underlying immunological mechanisms are unclear. A 56-year-old man presented with simultaneous acute progressive symmetric sensorimotor polyneuropathy and proteinuria. A kidney biopsy revealed focal segmental glomerulosclerosis. Serial electrophysiologic studies showed only a transient proximal conduction block in the median nerve, stimulated somatosensory evoked potential and prolonged terminal latencies of the median and peroneal nerves. The patient's neurologic deficits and kidney dysfunction recovered with corticosteroid treatment. Our case showed that somatosensory evoked potential study can be an important objective tool in the diagnosis of acute polyneuropathy with normal distal nerve conduction and that corticosteroids should be considered in the initial treatment of GBS-resembling polyneuropathy associated with nephrotic syndrome.
Evoked Potentials, Somatosensory/physiology ; Humans ; Male ; Middle Aged ; Nephrotic Syndrome/*diagnosis/*physiopathology ; Polyneuropathies/*diagnosis/*physiopathology