Validation of the Dutch Version of the DN4 Diagnostic Questionnaire for Neuropathic Pain

Abstract

Difficulties in diagnosing neuropathic pain in routine clinical practice support the need for validated and easy-to-use diagnostic tools. The DN4 neuropathic pain diagnostic questionnaire aims to discriminate neuropathic pain from nociceptive pain, but needs clinical validation. A total of 269 patients with chronic pain in three pain clinics were included in the study of which 248 had analyzable data. The mean duration of pain was 4.9 years. The most frequent etiologies were posttraumatic (36%), (pseudo) radicular (14%), and mechanical back pain (12%). The mean intensity of pain at visit was 5.6 on a 0-10 scale. Hundred and ninety-six of 248 patients had an identical pain diagnosis from both physicians: 85 had neuropathic pain, 57 had nociceptive pain, and 54 had mixed pain. Among patients with identical diagnoses of neuropathic or nociceptive pain, using a receiver operating characteristic curve analysis, the area under the curve (AUC) was 0.81 for the DN4 7-item and 0.82 for the 10-item version. A cutoff point of 5/10 for the full questionnaire resulted in a sensitivity of 75% and a specificity of 79%, while a cutoff point of 4/7 for the partial questionnaire resulted in a sensitivity of 74% and a specificity of 79%. The items "brushing," "painful cold," and "numbness" were most discriminating. The DN4 is an easy-to-use screening tool that is reliable for discriminating between neuropathic and nociceptive pain conditions in daily practice. Item-specific scores provide important information in addition to the total score.

Chronic Pain in Breast Cancer Survivors: Nociceptive, Neuropathic, or Central Sensitization Pain?

“…conducted a study concerning the validation of the Dutch version of the DN4 questionnaire. They concluded that a cut‐off point of 5/10 for the full questionnaire resulted in a sensitivity of 75% and a specificity of 79%, while a cut‐off point of 4/7 for the partial questionnaire resulted in a sensitivity of 74% and a specificity of 79% …”

Validation of the Greek Version of the DN4 Diagnostic Questionnaire for Neuropathic Pain

“…It is recognized that pain is always subjective and each person forms its understanding of the word through his experiences related to injury in early life . The need for a systematic classification of pain has long been recognized and IASP suggests 5 axes for the description of pain, according to anatomical location, body system involved, temporal characteristics, intensity, time of onset, and etiology . A broad categorization of pain, as nociceptive and/or neuropathic, is useful in clinical practice.…”

Estimating the Diagnostic Value of DN4 Versions

“…The authors concluded that a cutoff point of 5/10 for the Dutch Version of the DN4 resulted in a sensitivity of 75% and a specificity of 79% making thus the Dutch Version of the DN4 a diagnostic tool with a good ability to discriminate between neuropathic and nociceptive pain. We strongly believe that it is important to study the diagnostic value of DN4 in different languages as it has been shown that in different languages the cutoff points might differ slightly . Therefore, we congratulate the authors for undertaking this project.…”

“…We read with great interest the work of van Seventer and colleagues . The authors concluded that a cutoff point of 5/10 for the Dutch Version of the DN4 resulted in a sensitivity of 75% and a specificity of 79% making thus the Dutch Version of the DN4 a diagnostic tool with a good ability to discriminate between neuropathic and nociceptive pain.…”

“…The objective of the study was to discriminate between neuropathic and nociceptive pain. Choosing as specific as possible groups results in the least doubt about the type of pain, and so they therefore provide the most appropriate groups to analyze the discriminatory properties of the DN4 questionnaire …”