LANSS-scale and chronic pain syndrome

[Novice PT]

Hello!
I had a Mulligan concept course in Japan recently. They classified neural related pain in three categories.
One is neuropathic pain sensory hypersensitization such as CRPS. It cannot be treated by hands-on therapy but by mirror therapy.
Second is neuropathic pain denervation.
Third is peripheral nerve sensitization.
They said the first one is evaluated by LANSS-scale.
‘LANSS-scale’ have I never head or found in the Japanese PT journals or articles.
I also cannot find it in “Orthopedic physical assessment” by D.Magee.
In Japan CRPS is evaluated by pain disability index, pain disability assessment scale, or SF-36.
Is LANSS-scale accepted favorably by physios in the west countries?
Thanks in advance.
Novice PT

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[physiobob]

The LANSS Scale is the Leeds Assessment of Neuropathic Symptoms & Signs scale.

I have found a useful overview of it from The London Pain Clinic and have pasted that information below. I have also attached a questionnaire reprinted by another group.

Introduction

The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale is an assessment tool used by the medical community to analyze and classify pain.

In other words, it is a simple bedside test, conducted in two parts .i.e. a patient-completed questionnaire and a brief clinical assessment.

The primary purpose of this test is to assess whether the pain experienced is predominantly due to nerve damage or not. The LANSS scale is the only published tool with validity for discriminating between neuropathic and nociceptive pain, regardless if the disease-based diagnostic methods.

However, it important to note that the purpose of this test is to assist the clinicians in assessing the severity of the pain or its causes.

The Concept

The Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) comprises of a 7-item pain scale, including the sensory descriptors and items for sensory examination.

Out of the seven items in the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), five are symptom related and two are examination items. For the reader's benefit, we have furnished this list in the further sections.

In addition to the original LANSS pain scale, a modified S-LANSS or self-report LANSS test is also available that can be used by patients in the absence of a clinician.

According to various research reports, these LANSS tests correctly classified the patients as suffering from nociceptive and neuropathic pain, in four out of every five patients experiencing chronic pain.

Research Findings

Research reports strongly support the use of the LANSS pain scale for the classification of chronic pain.

In a recent study conducted to analyze the efficacy and accuracy of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale, it was found that the LANSS scale correctly identified 11 of 13 with the accurate category of neuropathic pain.

The LANSS Pain Scale

In this section, we have listed the 7-step questionnaire used a part of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale, along with suitable interpretations.

• Would you describe your pain as strange unpleasant sensations in your skin? (e.g. pricking, tingling, pins and needles) – Yes/No
• Does the skin in the painful areas look different to normal? (e.g. mottled, more red/pink than usual) – Yes/No
• Is the skin in the affected area abnormally sensitive to touch? (e.g. unpleasant sensations if lightly stroked, painful to wear tight clothes) – Yes/No
• Does your pain come on suddenly in bursts for no apparent reason when you are still? (e.g. like electric shocks, 'bursting' or 'jumping' sensations) – Yes/No
• Do you feel that skin temperature in the painful area has changed (e.g. hot, burning) – Yes/No
• Does stroking the affected area of skin with a piece of cotton wool produce an unpleasant painful sensation? – Yes/No
• Does touching the affected area of skin with a sharp needle feel sharper or duller when compared to an area of normal skin? – Yes/No

Both of the tests .i.e. LANSS and S-LANSS result in the patient being scored out of a total of 24. A patient with a score of 12 or more on this scale is diagnosed as suffering from neuropathic pain to some degree.

The above score can be used to assess the type of pain, whether it is neuropathic pain or not and also to assess your response to the treatment over a specific period of time.

Important Information

The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) has been found highly result-oriented and accurate in its assessments. However, experts suggest that there is still a small chance that a patient with a score below 12 on the scale might also be suffering from neuropathic pain. Similarly, a patient with a score of more than 12 might not be suffering from neuropathic pain.

Therefore, it is important that medical consultation is taken to confirm and verify the diagnosis made by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale as well as the S-LANSS scale.

[Novice PT]

Dear physiobob
Thank you very much for your kind reply.
Have you ever used LANSS-scale before? or how about your colleague physios?
Sincerely yours
(Another question apart from this topic)
There is a indication "Rep Power" in the left column. What is it?where is the instruction about it?

Novice PT

[physiobob]

This is nearly all part of the standard neuro assessment that we are taught as undergrads in Australia. Back then it did not have a name (when I was at university) and it seems most of this comes from normal practice guidelines that I still practice today.

[Novice PT]

Thank you for kind reply.
Lanss-scale is unfamiliar here in Japan.
Probably most of orthopaedists in Japan don't know it.
If it is widely accepted in western medical society, I would like to inform them of it.

Novice PT

[Novice PT]

I searched "LANSS-Scale" in the orthopedic journal "Spine" and "Journal of bone and joint surgery" which are accepted authoritative in Japaneseorthopedists.But I cannot find it at all.
In Japan the assertion of physios has not much weight in the medical society and mass-media.
The common sence in phisios will not be accepted in clinical settings which is ruled medical doctors in Japan.