Investigating the validity of the DN4 in a consecutive population of patients with chronic pain

Hans Timmerman; Monique A H Steegers; Frank J P M Huygen; Jelle J Goeman; Nick T van Dasselaar; Marcel J Schenkels; Oliver H G Wilder-Smith; André P Wolff; Kris C P Vissers

doi:10.1371/journal.pone.0187961

Investigating the validity of the DN4 in a consecutive population of patients with chronic pain

PLoS One. 2017 Nov 30;12(11):e0187961. doi: 10.1371/journal.pone.0187961. eCollection 2017.

Authors

Affiliations

¹ Radboud university medical center, Department of Anesthesiology, Pain and Palliative Medicine, Nijmegen, the Netherlands.
² ErasmusMC, Department of Anesthesiology, University Center of Pain Medicine, Rotterdam, the Netherlands.
³ Leiden University Medical Center, Department of Medical Statistics and Bioinformatics, Leiden, the Netherlands.
⁴ Reinier de Graaf Gasthuis, Department of Anesthesiology, Pain Medicine and Palliative Care, Delft, the Netherlands.
⁵ Bernhoven Ziekenhuis, department of Anesthesiology, Uden, the Netherlands.
⁶ Aalborg University, Center for Sensory-Motor Interaction, Aalborg, Denmark.
⁷ University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Pain Center, Groningen, the Netherlands.

Abstract

Neuropathic pain is clinically described as pain caused by a lesion or disease of the somatosensory nervous system. The aim of this study was to assess the validity of the Dutch version of the DN4, in a cross-sectional multicentre design, as a screening tool for detecting a neuropathic pain component in a large consecutive, not pre-stratified on basis of the target outcome, population of patients with chronic pain. Patients' pain was classified by two independent (pain-)physicians as the gold standard. The analysis was initially performed on the outcomes of those patients (n = 228 out of 291) in whom both physicians agreed in their pain classification. Compared to the gold standard the DN4 had a sensitivity of 75% and specificity of 76%. The DN4-symptoms (seven interview items) solely resulted in a sensitivity of 70% and a specificity of 67%. For the DN4-signs (three examination items) it was respectively 75% and 75%. In conclusion, because it seems that the DN4 helps to identify a neuropathic pain component in a consecutive population of patients with chronic pain in a moderate way, a comprehensive (physical-) examination by the physician is still obligate.

Publication types

Multicenter Study
Validation Study

MeSH terms

Adult
Aged
Chronic Pain / physiopathology*
Cross-Sectional Studies
Factor Analysis, Statistical
Female
Humans
Male
Middle Aged
Neuralgia / physiopathology*

Grants and funding

This study was performed within DALI for PAIN, a national program that focuses on neuropathic pain care optimalisation to APW. DALI for PAIN is an initiative of Pfizer. This project is supported by an unrestricted grant from Pfizer. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.