However, obstetrics is not practiced at the macro level. We should therefore consider complementing macro-level evaluations selleck bio with parallel evaluations at the meso level. Here, too, our integral descriptive model could play a useful role. Supplementary Material Author’s manuscript: Click here to view.(3.5M, pdf) Reviewer comments: Click here to view.(245K, pdf) Acknowledgments The authors thank the Netherlands Perinatal Registry for permission

to use the registry data. They especially thank Chantal Hukkelhoven and Leanne Houweling for their help in extracting the data from the Netherlands Perinatal Registry. They also thank Paul van der Linden, Hans Merkus, Mathieu Weggeman and Ruud Jonkers for their critical remarks on the key concept of their study and on the manuscript. Footnotes Contributors:

LH and HS initiated and coordinated the study. LH coordinated data collection and performed quality control of data. HS designed the key concept. Both authors actively participated in interpreting the results and revising the paper. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Competing interests: LH has been president of the board of the Netherlands Perinatal Registry until October 2013. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
Chronic neuropathic pain is defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.”1 It may be classified as central or peripheral, depending on the site of the lesion.2 Among the causes of chronic neuropathic pain are metabolic disease (eg, diabetes), infection (eg, shingles), trauma (eg, spinal cord injury) and autoimmune disease (eg, multiple sclerosis).3–5 The pain may be spontaneous or evoked in response to physical stimuli. The latter may manifest as increased sensitivity to pain (hyperalgesia) or as a painful response to a stimulus that would not normally be painful (allodynia).4 6 Chronic neuropathic pain is common worldwide, affecting 7% to 10% of the general population.7 It

is associated with depression, anxiety and sleep disturbances, and patients with chronic neuropathic pain experience lower health-related quality of life than the general population.8–11 Chronic neuropathic pain is associated with substantial economic burden. Tarride et al12 estimated that managing a Canadian patient with chronic Batimastat neuropathic pain over a 3-month period costs an average of $2567, of which 52% are direct costs, for example, cost of physicians, diagnostic tests and surgical procedures. Others report that people suffering from chronic neuropathic pain generate medical costs that are three times greater than those not living with pain.11 13 In the USA alone, almost $40 billion annually in healthcare, disability and related costs is attributed to chronic neuropathic pain.