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NEUROPATHIC PAIN Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system Neuropathic pain Pain usually results from activation of nociceptive afferents by actually or potentially tissue damaging stimuli. Pain may also arise by activity generated within the nervous system without adequate stimulation of its peripheral sensory endings. For this type of pain, the IASP introduced the term neuropathic pain. Treede et al. Neurology 2008 Kennedy et al 2007 IN PERIPHERAL PAINFUL NEUROPATHIES THE CORRELATION BETWEEN SKIN INNERVATION AND PAIN IS POOR THE ROLE OF SKIN BIOPSIES IN THE DIAGNOSIS OF PERIPHERAL PAINFUL NEUROPATHIES C. Sommer, University of Wuerzburg, Wuerzburg, Germany. (…) the correlation between measures of skin innervation and functional data, including pain, is poor, such that additional factors must play a role. Some patients with severe burning pain of the extremities have reduced skin innervation, which is normal in others. Among the factors that may play a role are central sensory pathways, local inflammatory cells and mediators, and further variables on the patient side. Fields 1987 PAINFUL NEUROPATHIES Distal axonal damage POSITIVE BIOPSY Death of sensory ganglion neurons Proximal axonal damage NEGATIVE BIOPSY No axonal damage