Sensitivity of the DN4 in Screening for Neuropathic Pain Syndromes
| Autor: | Catherine Smyth, Alexander J. Clark, Dwight E. Moulin, Larry W. Stitt, Elizabeth G. VanDenKerkhof, Patricia Morley-Forster, Mark A. Ware, Cory Toth, Mary E. Lynch, Howard J. Nathan, Allan Gordon |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Canada Neurological examination Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine Trigeminal neuralgia Internal medicine Surveys and Questionnaires medicine Humans 030212 general & internal medicine Prospective Studies Prospective cohort study Depression (differential diagnoses) Aged Pain Measurement Retrospective Studies medicine.diagnostic_test business.industry Odds ratio Middle Aged medicine.disease Anesthesiology and Pain Medicine Neuropathic pain Neuralgia Pain catastrophizing Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | The Clinical journal of pain. 34(1) |
| ISSN: | 1536-5409 |
| Popis: | Objectives: Several tools have been developed to screen for neuropathic pain. This study examined the sensitivity of the Douleur Neuropathique en 4 Questions (DN4) in screening for various neuropathic pain syndromes. Materials and methods: This prospective observational study was conducted in 7 Canadian academic pain centers between April 2008 and December 2011. All newly admitted patients (n=2199) were approached and 789 eligible participants form the sample for this analysis. Baseline data included demographics, disability, health-related quality of life, and pain characteristics. Diagnosis of probable or definite neuropathic pain was on the basis of history, neurological examination, and ancillary diagnostic tests. Results: The mean age of study participants was 53.5 years and 54.7% were female; 83% (n=652/789) screened positive on the DN4 (≥4/10). The sensitivity was highest for central neuropathic pain (92.5%, n=74/80) and generalized polyneuropathies (92.1%, n=139/151), and lowest for trigeminal neuralgia (69.2%, n=36/52). After controlling for confounders, the sensitivity of the DN4 remained significantly higher for individuals with generalized polyneuropathies (odds ratio [OR]=4.35; 95% confidence interval [CI]: 2.15, 8.81), central neuropathic pain (OR=3.76; 95% CI: 1.56, 9.07), and multifocal polyneuropathies (OR=1.72; 95% CI: 1.03, 2.85) compared with focal neuropathies. Discussion: The DN4 performed well; however, sensitivity varied by syndrome and the lowest sensitivity was found for trigeminal neuralgia. A positive DN4 was associated with greater pain catastrophizing, disability and anxiety/depression, which may be because of disease severity, and/or these scales may reflect magnification of sensory symptoms and findings. Future research should examine how the DN4 could be refined to improve its sensitivity for specific neuropathic pain conditions. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|