Cruccu, G.

Marchettini, P.

Solaro, C.

Sommer, C.

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Thus, the questionnaire on neuropathic pain proposedto European neurologists by Sommer and colleagues is tobe praised for fostering awareness of neuropathic pain asa diagnostic challenge among specialists who by traditionhave shown little interest in pain management [2]. Asacknowledged by the authors, most of the answers comefrom only 4 countries, albeit with a widespread geograph-ical, cultural and economic representation. The surveyreports surprising data, seemingly contradicting theassumption that neurologists are not interested in pain: themajority of the 745 respondents stated they are familiarwith neuropathic pain, 33.6% of them declared they seeneuropathic pain cases daily and 41.5% weekly.Unfortunately, on closer scrutiny the data on theEuropean neurologists’ expertise in diagnosing neuropath-ic pain are not so reassuring. The survey collected only theresponses of the neurologists willing to answer the ques-tionnaire, a selection that obviously leads to overestimat-ing the findings. In addition, the responses provided do notdemonstrate the claimed level of familiarity: the majorityof respondents mentioned widespread peripheral neuro-pathic pain conditions (diabetic neuropathy, radiculopathyand trigeminal neuralgia) that should be familiar to gener-al practitioners, while other common neuropathic painconditions such as post-herpetic neuralgia and nerveentrapment were mentioned by only one third of therespondents. The percentage of the respondents familiarwith central pain and nerve injury pain was less than onequarter; a quite disappointing figure for those who shouldbe specialists in diagnosing neuropathic pain conditionsand have a declared interest in the subject.Given this level of information, the statement thatNSAIDS are still prescribed for treating neuropathic paincomes as no surprise, as does the seemingly contradictoryreport that antidepressants are the most used drug catego-ry, while gabapentin is the single most used drug. (The sur-vey was launched before the introduction of pregabalinand duloxetine for treating neuropathic pain; at that timeNeurol Sci (2007) 28:161–162DOI 10.1007/s10072-007-0812-2P. Marchettini • C. SolaroTo become a pain specialist one has to understand the nervous system,yet the specialists of the nervous system still have a long way to gobefore understanding painN E W S  A N D  V I E W SA survey on chronic pain in Europe based on a huge pop-ulation interview available on-line since 2005 reports thatan average of 19% of adult Europeans suffer from a chron-ic pain condition that in 40% of cases is not adequately con-trolled [1]. More than half of the patients interviewed usedNSAIDS as the drug of choice, thus it is tempting to putforward the hypothesis that poor pain management is due toinadequate recognition of the cause of the pain. NSAIDSare not the drug of choice for neuropathic pain, while thistype of pain ranks highly among the causes of chronic pain,either as an isolated cause (peripheral neuropathies andcentral pains) or jointly with osteoarthritis (cervical andlumbar-sacral radiculopathy). Indeed, European physiciansstill have a long way to go to improve chronic pain man-agement and certainly there is room for improvement in theproper diagnosis of neuropathic pain.P. Marchettini ()Pain Medicine Centre, Scientific Institute San RaffaeleVia Olgettina 58, I-20132 Milan, Italye-mail: marchettini.paolo@hsr.itP. MarchettiniPain Physiopathology and TherapyProfessional University School of LuganoTicino, SwitzerlandC. SolaroDepartment of NeurologyASL3 genovese, Genova, Italythe only effective antidepressants were the tricyclics,while the choice of antiepileptics was slightly wider.) Aspinpointed by the authors, some of the respondents alsofailed in recognising VAS and NRS among the pain scales,an additional indirect indication that familiarity with painmanagement was lower than that stated. Many neuropath-ic pain conditions are very difficult to treat and requirecomprehensive evaluation and at times even invasive ther-apies; it is also surprising that the respondents were sosuccessful in achieving 75% pain relief and only 3% need-ed to refer patients to pain clinics.Taking all this into consideration, we do not share theoptimism of the authors of this survey on the attitude ofEuropean neurologists toward neuropathic pain. Rather,we believe that much more information is needed on thissubject. However, we strongly agree with the final state-ment of Sommer and colleagues that “neurologists alsosee the necessity for more education and for improvementof the treatment of neuropathic pain” and indeed, despiteall the mentioned limitations of this study, we praise theauthors for calling attention to this neurological chal-lenge.References1. Breivik H, Collett B, Ventafridda V et al (2006) Survey ofchronic pain in Europe: prevalence, impact on daily life,and treatment. Eur J Pain 10:287–3332. Sommer C, Geis C, Haanpää M et al (2007) Questionnaireon neuropathic pain: a European Neurologist survey.Neurol Sci 28:136–141162Reply from the authorWe thank the correspondents for their critical praise of oursurvey. Indeed, we agree with most of the points raised. By allmeans the neurologists who answered our questionnaire werea positive selection, as they were obviously interested in thesubject of neuropathic pain. Even within this motivatedgroup, there were some doubts on the use of standardised painscales, thus neurologists do need more education in this field.One point was misunderstood by Marchettini and Solaro. Wedid not ask whether the physicians were familiar with diabet-ic neuropathy, central pain and so on; we asked them whichwere the most frequently seen diagnoses. This explains whythe comparatively rarer conditions, such as central neuropath-ic pain, were mentioned by fewer participants. The reasonwas not that they were unfamiliar with central pain.The interest in our results has motivated us to engage in anew survey with an improved strategy to avoid bias and alsoan improved set of questions. We are confident that actionslike this will increase the awareness of this challenging partof neurology and will hopefully, in the long run, improvepatient management.C. SommerDepartment of NeurologyUniversity of WürzburgJosef-Schneider-Str. 11, D-97080Würzburg, Germanye-mail: sommer@mail.uni-wuerzburg.deG. CruccuDepartment of Neurological SciencesLa Sapienza University, Rome, ItalyP. Marchettini, C. Solaro: European neurologists command on neuropathic pain: facts and fantasies

To become a pain specialist one has to understand the nervous system, yet the specialists of the nervous system still have a long way to go before understanding pain

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To become a pain specialist one has to understand the nervous system, yet the specialists of the nervous system still have a long way to go before understanding pain

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