**12. Clinical history**

By definition, neuropathic pain indicates direct pathology of the nervous system while nociceptive pain is an indication of real or potential tissue damage. Due to the distinction in pathophysiology, conventional treatments prescribed for nociceptive pain are not very effective in treating neuropathic pain and vice versa [78]. Therefore the first step towards meaningful pain relief is an accurate diagnosis.

Identifying neuropathic pain in a clinical setting begins with a thorough review of the patient's history through evaluation of previous medical records and verbal communication with the patient. Standardized screening tools such as the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) [79], the Douleur Neuropathique en 4 questions (DN4) [12], and painDE‐ TECT [13] can guide clinician through a series of questions aimed at indentifying possible neuropathic pain. In completing these questionnaires patients are asked to describe their pain in terms of quality (i.e. pricking, tingling, pins and needles, electric shocks/shooting, burning) and context (i.e. provoked by heat, cold, or pressure) [80]. In addition to verbal descriptors, the LANSS and DN4 also include a short bedside examination of sensory abnormalities. Although each screening tool is unique, they have similar sensitivity and specificity, between 80-85% for both parameters [80]. This suggests that approximately 1 in 5 patients who fit the criteria for neuropathic pain as determined by the screening tool and 20% of all individuals who've been evaluated are misdiagnosed. This reaffirms that careful clinical judgment is necessary to make an accurate diagnosis.

Additional information that is not included within the standardized questionnaires can also be useful in diagnosing neuropathic pain. Mapping pain topography allows the clinician to consider whether a lesion is anatomically logical, and descriptions of frequency (i.e. on-going, spontaneous) and intensity (e.g. mild, moderate, severe, excruciating or 1-10) can aid in identifying a potential mechanism [1].
