Table 3 Evidence-Based Diagnostic Criteria for a Working Diagnosis of Conditions Arising From Neuropathic Processes
Neuropathic pain •History of lesion or disease of nervous system•Comorbidities relating to neuropathic pain•Pain neuroanatomically distributed•Sensory dysfunction neuroanatomically distributed•Burning, shooting, or pricking pain description Expert consensus-based IASP criteria [12, 21]
Radicular pain •Lancinating•Travels along narrow region•Pain beyond the spine•May be episodic, recurrent, or paroxysmal Expert consensus criteria [44]
Radiculopathy •Objective findings of nerve root conduction loss in the distribution of a spinal nerve (eg, reduced deep tendon reflex, reduced motor strength, and/or reduced sensation corresponding to a nerve root) Expert consensus criteria [44]
Neurogenic claudication •Symptoms triggered with standing•Symptoms relieved when sitting•Symptoms primarily located above knees•Positive shopping cart sign Diagnostic study using expert diagnosis, imaging, and vascular testing [45]
Piriformis syndrome •Radiating pain into an ipsilateral leg•Tenderness of the greater sciatic notch•Buttock pain•Positive SLR test•Increased pain with prolonged sitting Most common characteristics described in the clinical literature [16]
Thoracolumbar (Maigne’s) syndrome •Pain in cluneal nerve distribution (iliac crest, groin, or greater trochanter)•Trigger point over iliac crest approximately 7 cm from midline•Sensitivity to iliac crest skin rolling•Tenderness of 1 or more thoracolumbar spinous processes or facet joints Expert description of condition [46, 47]
Central sensitization •Low back pain disproportionate to nature or extent of injury/pathology (ie, there is insufficient evidence for tissue injury, pathology, or other dysfunction to explain self-reported symptoms)•Neuroanatomically illogical pattern (eg, pain varying in location, abnormally large painful area, completely symmetrical pain pattern)•Hypersensitivity of senses unrelated to musculoskeletal system (eg, heat, cold, or pressure hypersensitivity; generalized sensitivity remote from low back area; hypersensitivity to light, sound, stress, food, chemical stimuli) Expert consensus criteria [12]
IASP, International Association for the Study of Pain; SLR, straight leg raise.