Neuropathic Pain Management in Rehabilitation: Investigating Prescribing Practices and Pain Scores in Inpatients at a Rehabilitation Hospital

Pain is a prevalent and complex symptom in neurorehabilitation, with differentiation between neuropathic pain (NP) and musculoskeletal pain (MSK) often proving challenging. This study evaluates the effectiveness of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Douleur Neuropathique en 4 Questions (DN4) tools in distinguishing NP from MSK pain, aiming to guide appropriate analgesic selection in a rehabilitation setting. Seventy inpatients undergoing active rehabilitation (32 males, 38 females) aged 18-91 years (mean: 67 years) were assessed using LANSS and DN4 scores over a 2-week period. Prescribed analgesia was recorded and correlated with pain classification based on these scores. The results showed that stroke patients exhibited a higher prevalence of NP, reflected in elevated LANSS and DN4 scores. Spinal cord injury (SCI) patients had the highest total scores, often necessitating dual therapy with pregabalin and amitriptyline. Conversely, patients with fractures had the lowest scores, suggesting predominantly MSK pain, with minimal neuropathic features. Pregabalin was prescribed to 29% of stroke patients but only 6% of fracture patients. In conclusion, LANSS and DN4 effectively identified NP, with DN4 proving easier to interpret. Findings underscore the need for targeted analgesic strategies in neurorehabilitation particularly that of NP in stroke and SCI patients. This is still under-researched in literature, compared to conditions like diabetic neuropathy, and future studies are needed to explore tailored pain management protocols in rehabilitation patients.