Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).
Few studies have directly compared the clinical features of neuropathic and non-neuropathic pains. For this purpose, the French Neuropathic Pain Group developed a clinician-administered questionnaire named DN4 consisting of both sensory descriptors and signs related to bedside sensory examination. This questionnaire was used in a prospective study of 160 patients presenting with pain associated with a definite neurological or somatic lesion. The most common aetiologies of nervous lesions (n=89) were traumatic nerve injury, post herpetic neuralgia and post stroke pain. Non-neurological lesions (n=71) were represented by osteoarthritis, inflammatory arthropathies and mechanical low back pain. Each patient was seen independently by two experts in order to confirm the diagnosis of neuropathic or non-neuropathic pain. The prevalence of pain descriptors and sensory dysfunctions were systematically compared in the two groups of patients. The analysis of the psychometric properties of the DN4 questionnaire included: face validity, inter-rater reliability, factor analysis and logistic regression to identify the discriminant properties of items or combinations of items for the diagnosis of neuropathic pain. We found that a relatively small number of items are sufficient to discriminate neuropathic pain. The 10-item questionnaire developed in the present study constitutes a new diagnostic instrument, which might be helpful both in clinical research and daily practice.
Bouhassira
Didier
D
INSERM E-332, AP-HP Hôpital Ambroise Paré, Boulogne and Université Versailles-Saint-Quentin, France. didier.bouhassira@apr.ap-hop-paris.fr
Attal
Nadine
N
Alchaar
Haiel
H
Boureau
François
F
Brochet
Bruno
B
Bruxelle
Jean
J
Cunin
Gérard
G
Fermanian
Jacques
J
Ginies
Patrick
P
Grun-Overdyking
Aurélie
A
Jafari-Schluep
Hélène
H
Lantéri-Minet
Michel
M
Laurent
Bernard
B
Mick
Gérard
G
Serrie
Alain
A
Valade
Dominique
D
Vicaut
Eric
E
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology*; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology; D012680:Sensitivity and Specificity; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology; D013577:Syndrome