LANSS Pain Scale

LANSS Pain Scale (Leeds Assessment of Neuropathic Symptoms & Signs) can help to determine whether the nerves carrying pain signals are working normally or not. It is important to find this out in case different treatments are needed to control your pain.

The LANSS pain scale was developed by Bennett, and it is a seven-item scale consisting of five questions about sensory experiences, including dysesthesia, autonomic dysfunction, evoked pain, paroxysmal pain, and thermal pain and two items based on a bedside examination (allodynia and pinprick threshold) of the painful area.

LANSS Pain Scale Sections

PAIN QUESTIONNAIRE

Think about how your pain has felt over the last week. Please say whether any of the descriptions match your pain exactly.

Does your pain feel like strange, unpleasant sensations in your skin? Words like pricking, tingling, pins and needles might describe these sensations.

a) NO – My pain doesn’t really feel like this	0
b) YES – I get these sensations quite a lot	5

Does your pain make the skin in the painful area look different from normal? Words like mottled or looking more red or pink might describe the appearance.

a) NO – My pain doesn’t affect the colour of my skin	0
b) YES – I’ve noticed that the pain does make my skin look different from normal	5

Does your pain make the affected skin abnormally sensitive to touch? Getting unpleasant sensations when lightly stroking the skin, or getting pain when wearing tight clothes might describe the abnormal sensitivity.

a) NO – My pain doesn’t make my skin abnormally sensitive in that area	0
b) YES – My skin seems abnormally sensitive to touch in that area	3

Does your pain come on suddenly and in bursts for no apparent reason when you’re still.Words like electric shocks, jumping, and bursting describe these sensations.

a) NO – My pain doesn’t really feel like this	0
b) YES – I get these sensations quite a lot	2

Does your pain feel as if the skin temperature in the painful area has changed abnormally? Words like hot and burning describe these sensations.

a) NO – I don’t really get these sensations	0
b) YES – I get these sensations quite a lot	1

SENSORY TESTING

Skin sensitivity can be examined by comparing the painful area with a contralateral or adjacent non-painful area for the presence of allodynia and an altered pinprick threshold (PPT).

ALLODYNIA (Pain caused by something that normally would not cause pain)
Examine the response to lightly stroking cotton wool across the non-painful area and then the painful area. If normal sensations are experienced in the non-painful site, but pain or unpleasant sensations (e.g., tingling, nausea) are experienced in the painful area when stroking, allodynia is present.

a) NO, normal sensation in both areas	0
b) YES, allodynia in painful area only	5

ALTERED PINPRICK THRESHOLD
Determine the pinprick threshold by comparing the response to a 23-gauge (blue) needle mounted inside a 2-mL syringe barrel placed gently on to the skin in a non-painful and then painful areas.

If a sharp pinprick is felt in the non-painful area, but a different sensation is experienced in the painful area (e.g., none/blunt only [raised PPT] or a very painful sensation [lowered PPT]), an altered PPT is present.

If a pinprick is not felt in either area, mount the syringe onto the needle to increase the weight and repeat

a) NO, equal sensation in both areas	0
b) YES, altered PPT in painful area	3

LANSS Pain Scale Scoring

• If score <12, neuropathic mechanisms are unlikely to be contribution to the patient’s pain.
• If score ≥12, neuropathic mechanisms are likely to be contribution to the patient’s pain.

Maximum LANSS Pain Scale Score is 24.

One study used LANSS Pain Scale in patients with bilateral painful CTS and used an adjacent non-painful area as the control, as described by Bennett. The results showed that neuropathic pain based on LANSS may be found in 47.6% of CTS hands. The results presented herein demonstrate that the presence of evoked pain and allodynia might be associated with more severe electrophysiological impairment, although neuropathic pain assessed with a total LANSS score is not correlated with electrophysiological CTS severity. Therefore, neuropathic pain in patients with CTS should be handled and treated independently from electrophysiological data.

See Also: Carpal Tunnel Syndrome

References & More

1. Gürsoy AE, Kolukısa M, Yıldız GB, Kocaman G, Celebi A, Koçer A. Relationship between electrodiagnostic severity and neuropathic pain assessed by the LANSS pain scale in carpal tunnel syndrome. Neuropsychiatr Dis Treat. 2013;9:65-71. doi: 10.2147/NDT.S38513. Epub 2013 Jan 7. PMID: 23326196; PMCID: PMC3544346. Pubmed
2. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001 May;92(1-2):147-57. doi: 10.1016/s0304-3959(00)00482-6. PMID: 11323136. Pubmed
3. Orthopedic Physical Assessment by David J. Magee, 7th Edition.