pain DETECT : a new screening questionnaire to identify neuropathic components in patients with back pain
Open accessAbstract
OBJECTIVE: Nociceptive and neuropathic components both contribute to pain. Since these components require different pain management strategies, correct pain diagnosis before and during treatment is highly desirable. As low back pain (LBP) patients constitute an important subgroup of chronic pain patients, we addressed the following issues: (i) to establish a simple, validated screening tool to detect neuropathic pain (NeP) components in chronic LBP patients, (ii) to determine the prevalence of neuropathic pain components in LBP in a large-scale survey, and (iii) to determine whether LBP patients with an NeP component suffer from worse, or different, co-morbidities. METHODS: In co-operation with the German Research Network on Neuropathic Pain we developed and validated the painDETECT questionnaire (PD-Q) in a prospective, multicentre study and subsequently applied it to approximately 8000 LBP patients. RESULTS: The PD-Q is a reliable screening tool with high sensitivity, specificity and positive predictive accuracy; these were 84% in a palm-top computerised version and 85%, 80% and 83%, respectively, in a corresponding pencil-and-paper questionnaire. In an unselected cohort of chronic LBP patients, 37% were found to have predominantly neuropathic pain. Patients with NeP showed higher ratings of pain intensity, with more (and more severe) co-morbidities such as depression, panic/anxiety and sleep disorders. This also affected functionality and use of health-care resources. On the basis of given prevalence of LBP in the general population, we calculated that 14.5% of all female and 11.4% of all male Germans suffer from LBP with a predominant neuropathic pain component. CONCLUSION: Simple, patient-based, easy-to-use screening questionnaires can determine the prevalence of neuropathic pain components both in individual LBP patients and in heterogeneous cohorts of such patients. Since NeP correlates with more intense pain, more severe co-morbidity and poorer quality of life, accurate diagnosis is a milestone in choosing appropriate therapy.
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Randomization uses stratified blocks by sex/gender and pain type to balance these factors across the three arms.
“Participants will be randomized to stratified blocks based on sex/gender and pain type (neuropathic, non-neuropathic, mixed or undetermined), assessed via the Pain DETECT[50] measure and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)[51] to ensure uniform distribution of these factors across the three conditions.”
From The chronic pain skills study: Protocol for a randomized controlled trial comparing hypnosis, mindfulness meditation and pain education in Veterans (2020) · cites this paper as [51]
The BPI is a popular well-validated measure of pain severity used in research and clinical settings.
“This is a popular well-validated measure of pain severity used in research and clinical settings.”
From Risk Factors for Self-Harm Ideation among Persons Treated with Opioids for Chronic Low Back Pain (2023) · cites this paper as [33]
The Discussion describes painDETECT (PD-Q) as a validated screening tool for neuropathic pain, not the BPI as a measure of pain severity. Searches for “BPI,” “Brief Pain Inventory,” and the claimed description found no passage in our copy addressing the BPI’s validation or use. (LLM, conf=0.75)
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“0% of those with chronic low back pain had a predominantly neuropathic component to their pain [27].”
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A Novel Tool for the Assessment of Pain: Validation in Low Back Pain
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“for neuropathic pain [45–47], the DN4 relies largely on a structured exploration of the patient’s history.”
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Steegers, M. A. H., Snik, D. M., Verhagen, A. F. T. M., van der Drift, M. A., & Wilder‐Smith, O. H. G. (2008) · Journal of Pain · doi:10.1016/j.jpain.2008.05.009 · Cited by 258 · see citing works
Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management
Clauw, D. J., Essex, M. N., Pitman, V. W., & Jones, K. D. (2019) · Postgraduate Medicine · doi:10.1080/00325481.2019.1574403 · Cited by 262 · see citing works
“PainDETECT in patients with chronic lower back pain (neuropathic) [140]; and the Revised Fibromyalgia Impact”
BackgroundCancer Pain Assessment and Classification
Caraceni, A. T., & Shkodra, M. (2019) · Cancers · doi:10.3390/cancers11040510 · Cited by 256 · see citing works
Diagnosis and assessment of neuropathic pain through questionnaires
Attal, N., Bouhassira, D., & Baron, R. (2018) · The Lancet Neurology · doi:10.1016/s1474-4422(18)30071-1 · Cited by 255 · see citing works
Self-citationBuynak, R. J., Shapiro, D. Y., Okamoto, A., Hove, I. V., Rauschkolb, C., Steup, A., Lange, B., Lange, C., & Etropolski, M. S. (2010) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2010.497720 · Cited by 252 · see citing works
“Low back pain may have both nociceptive and neuropathic pain components [1,62,63].”
BackgroundOsteoarthritis pain: nociceptive or neuropathic?
Thakur, M., Dickenson, A. H., & Baron, R. (2014) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2014.47 · Cited by 251 · see citing works
Self-citationHochman, J. R., Davis, A. M., Elkayam, J. G., Gagliese, L., & HAWKER, G. A. (2013) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2013.06.023 · Cited by 249 · see citing works
McAlindon, T. E., Driban, J. B., Henrotin, Y. E., Hunter, D. J., Jiang, G.-L., Skou, S. T., Wang, S., & Schnitzer, T. J. (2015) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2015.03.005 · Cited by 252 · see citing works
Pregabalin Reduces Pain in Patients With Chronic Pancreatitis in a Randomized, Controlled Trial
Olesen, S. S., Bouwense, S. A. W., Wilder‐Smith, O. H. G., van Goor, H., & Drewes, A. M. (2011) · Gastroenterology · doi:10.1053/j.gastro.2011.04.003 · Cited by 241 · see citing works
Composite Pain Biomarker Signatures for Objective Assessment and Effective Treatment
Tracey, I., Woolf, C. J., & Andrews, N. A. (2019) · Neuron · doi:10.1016/j.neuron.2019.02.019 · Cited by 231 · see citing works
“DN4 and PainDetect for neuropathic pain) and their specificity, sensitivity and reliability is being validated (Bouhassira et al., 2005; Freynhagen et al., 2006; Haanpaa et al., 2011).”
BackgroundDoggweiler, R., Whitmore, K. E., Meijlink, J. M., Drake, M. J., Frawley, H., Nordling, J., Hanno, P., Fraser, M. O., Homma, Y., Garrido, G., et al. (2017) · Neurourology and Urodynamics · doi:10.1002/nau.23072 · Cited by 230 · see citing works
Primary afferent input critical for maintaining spontaneous pain in peripheral neuropathy
Haroutounian, S., Nikolajsen, L., Bendtsen, T. F., Finnerup, N. B., Kristensen, A. D., Hasselstrøm, J. B., & Jensen, T. S. (2014) · Pain · doi:10.1016/j.pain.2014.03.022 · Cited by 230 · see citing works
“The patients completed the following questionnaires at baseline: Hospital Anxiety and Depression Scale [45], Brief Pain Inventory [33], Neuropathic Pain Symptom Inventory [5], and PainDETECT [11].”
MethodAssessment and pathophysiology of pain in cardiac surgery
Zubrzycki, M., Liebold, A., Skrabal, C. A., Reinelt, H., Ziegler, M., Perdas, E., & Zubrzycka, M. (2018) · Journal of Pain Research · doi:10.2147/jpr.s162067 · Cited by 231 · see citing works
Vilholm, O. J., Cold, S., Rasmussen, L., & Sindrup, S. H. (2008) · British Journal of Cancer · doi:10.1038/sj.bjc.6604534 · Cited by 230 · see citing works
Assessment of Neuropathic Pain in Primary Care
Haanpää, M. L., Backonja, M.-M., Bennett, M. I., Bouhassira, D., Cruccu, G., Hansson, P. T., Jensen, T. S., Kauppila, T., Rice, A. S. C., Smith, B. H., et al. (2009) · The American Journal of Medicine · doi:10.1016/j.amjmed.2009.04.006 · Cited by 223 · see citing works
Self-citationDisrupted functional connectivity of the periaqueductal gray in chronic low back pain
Yu, R., Gollub, R. L., Spaeth, R. B., Napadow, V., Wasan, A. D., & Kong, J. (2014) · NeuroImage Clinical · doi:10.1016/j.nicl.2014.08.019 · Cited by 220 · see citing works
Muscle Control and Non-specific Chronic Low Back Pain
Russo, M., Deckers, K., Eldabe, S., Kiesel, K., Gilligan, C., Vieceli, J., & Crosby, P. (2018) · Neuromodulation: Technology at the Neural Interface · doi:10.1111/ner.12738 · Cited by 222 · see citing works
Pain imaging in health and disease — how far have we come?
Schweinhardt, P., & Bushnell, M. C. (2010) · Journal of Clinical Investigation · doi:10.1172/jci43498 · Cited by 221 · see citing works
Current understanding of the mixed pain concept: a brief narrative review
Freynhagen, R., Parada, H. A., Calderón‐Ospina, C., Chen, J., Emril, D. R., Fernández-Villacorta, F. J., Franco, H., Ho, K., Lara-Solares, A., Li, C. C., et al. (2018) · Current Medical Research and Opinion · doi:10.1080/03007995.2018.1552042 · Cited by 222 · see citing works
Self-citationTrial of pregabalin for acute and chronic sciatica
Mathieson, S., Maher, C. G., McLachlan, A. J., Latimer, J., Koes, B. W., Hancock, M. J., Harris, I., Day, R. O., Billot, L., Pik, J., et al. (2017) · New England Journal of Medicine · doi:10.1056/nejmoa1614292 · Cited by 219 · see citing works
Predictive factors for the development of persistent pain after breast cancer surgery
Andersen, K. G., Duriaud, H. M., Jensen, H. E., Kroman, N., & Kehlet, H. (2015) · Pain · doi:10.1097/j.pain.0000000000000298 · Cited by 213 · see citing works
“Opioids 12 (2) 56 (11) 13 (3) 16 (3) 22 (5) Special 5 (1) 21 (4) 18 (4) 4 (1) 6 (1) PainDetect score $19, N (%) 35 (6) 91 (18) 76 (16) 64 (14)”
Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review.
Frey, M. E., Manchikanti, L., Benyamin, R. M., Schultz, D. M., Smith, H. S., & Cohen, S. P. (2009) · PubMed · Cited by 217 · see citing works
Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms
Kaplan, C. M., Kelleher, E. M., Irani, A., Schrepf, A., Clauw, D. J., & Harte, S. E. (2024) · Nature Reviews Neurology · doi:10.1038/s41582-024-00966-8 · Cited by 231 · see citing works
“Abnormal scores on neuropathic pain questionnaires, such as PainDE-TECT 21 , can help to distinguish features of neuropathic pain from those of nociplastic pain 11,22,23 .”
Brummett, C. M., Janda, A. M., Schueller, C. M., Tsodikov, A. D., Morris, M., Williams, D. A., & Clauw, D. J. (2013) · Anesthesiology · doi:10.1097/aln.0b013e3182a8eb1f · Cited by 210 · see citing works
Smart, K. M., Blake, C. M., Staines, A. S., & Doody, C. (2009) · Manual Therapy · doi:10.1016/j.math.2009.07.005 · Cited by 206 · see citing works
“The ‘peripheral neuropathic’ pain criteria generated form this Delphi survey appear to largely concur with those criteria described in a number of existing screening tools developed specifically to identify pain of (peripheral) neuropathic origin; including the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)…”
Management of Osteoarthritis: Expert Opinion on NSAIDs
Magni, A., Agostoni, P., Bonezzi, C., Massazza, G., Menè, P., Savarino, V., & Fornasari, D. (2021) · Pain and Therapy · doi:10.1007/s40122-021-00260-1 · Cited by 201 · see citing works
“The most used tools to discriminate neuropathic pain from non-neuropathic pain in clinical settings include painDETECT [36], the Leeds assessment of neuropathic symptoms and signs Pain Scale [37] and the Douleur Neuropathique 4 questions [38]; all of these tools rely on the description of pain and on the bedside exami…”
MethodNeuropathic cancer pain: prevalence, pathophysiology, and management
Yoon, S. Y., & Oh, J. (2018) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.2018.162 · Cited by 201 · see citing works
“PainDETECT is a self-reporting questionnaire with nine items, originally developed to detect the neuropathic component of chronic lower back pain [33].”
BackgroundTranslation to Portuguese and Validation of the Douleur Neuropathique 4 Questionnaire
Santos, J. G., Brito, J. O., de Andrade, D. C., Kaziyama, V. M., Ferreira, K. A. S. L., Souza, I., Teixeira, M. J., Bouhassira, D., & Baptista, A. F. (2009) · Journal of Pain · doi:10.1016/j.jpain.2009.09.014 · Cited by 200 · see citing works
Pathology of pain and its implications for therapeutic interventions
Cao, B., Xu, Q., Shi, Y., Zhao, R., Li, H., Zheng, J., Liu, F., Wan, Y., & Wei, B. (2024) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-024-01845-w · Cited by 220 · see citing works
The nerve of osteoarthritis pain
Hochman, J. R., French, M., Bermingham, S. L., & HAWKER, G. A. (2010) · Arthritis Care & Research · doi:10.1002/acr.20142 · Cited by 197 · see citing works
“, chronic low back pain, pain of any cause), an association has been found between pain intensity and NP symptoms (12,14).”
BackgroundÜnal-Çevik, I., Ay, S., & Evcik, D. (2010) · Journal of Pain · doi:10.1016/j.jpain.2010.02.003 · Cited by 195 · see citing works
The painDETECT project – far more than a screening tool on neuropathic pain
Freynhagen, R., Tölle, T. R., Gockel, U., & Baron, R. (2016) · Current Medical Research and Opinion · doi:10.1185/03007995.2016.1157460 · Cited by 195 · see citing works
“The 37% of patients found to have NeP in LBP by Freynhagen et al. mark the high end of the range found in the studies, in which the percentage of patients with NeP varied from 2.6% (Beith et al.19; subgroup of LBP patients with no leg involvement) to 37.9%20.”
BackgroundMethodInfluentialSelf-citationDiagnosis and management of neuropathic pain
Freynhagen, R., & Bennett, M. (2009) · BMJ · doi:10.1136/bmj.b3002 · Cited by 194 · see citing works
Self-citationSmart, K. M., Blake, C. M., Staines, A. S., Thacker, M. A., & Doody, C. (2012) · Manual Therapy · doi:10.1016/j.math.2012.03.013 · Cited by 193 · see citing works
“…¼ 35) or indeterminate (n ¼ 1) pain state were excluded on the grounds that any discriminatory clusters of symptoms and signs would be more clearly identified from those patients classified with a dominance of CSP, a practice in keeping with similar studies (Bennett, 2001; Freynhagen et al., 2006).”
ResultPark, S., Park, J.-W., Jang, H. S., Heo, Y. W., Han, H., Kim, H., Chang, B., Lee, C., & Yeom, J. S. (2019) · The Spine Journal · doi:10.1016/j.spinee.2019.09.015 · Cited by 193 · see citing works
Müller, R., Gertz, K. J., Molton, I. R., Terrill, A. L., Bombardier, C. H., Ehde, D. M., & Jensen, M. P. (2016) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000225 · Cited by 179 · see citing works
“78) (24-81) Missing 0 2 2 Sex Male 17 (33.”
Brummett, C. M., Urquhart, A. G., Hassett, A. L., Tsodikov, A., Hallstrom, B. R., Wood, N. I., Williams, D. A., & Clauw, D. J. (2015) · Arthritis & Rheumatology · doi:10.1002/art.39051 · Cited by 195 · see citing works
Freynhagen, R., Rolke, R., Baron, R., Tölle, T. R., Rutjes, A.-K., Schu, S., & Treede, R. (2007) · Pain · doi:10.1016/j.pain.2007.05.004 · Cited by 189 · see citing works
Self-citationSmart, K. M., Blake, C. M., Staines, A. S., & Doody, C. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318215f16a · Cited by 188 · see citing works
Mechanisms for Joint Pain in Rheumatoid Arthritis (RA): from Cytokines to Central Sensitization
Zhang, A., & Lee, Y. (2018) · Current Osteoporosis Reports · doi:10.1007/s11914-018-0473-5 · Cited by 185 · see citing works
Fonoff, E. T. (2012) · Pain Physician · doi:10.36076/ppj.2012/15/e115 · Cited by 183 · see citing works
Cohen, S. P., Argoff, C. E., & Carragee, E. J. (2008) · BMJ · doi:10.1136/bmj.a2718 · Cited by 183 · see citing works
Schilder, A., Hoheisel, U., Magerl, W., Benrath, J., Klein, T., & Treede, R. (2013) · Pain · doi:10.1016/j.pain.2013.09.025 · Cited by 181 · see citing works
Persistent postsurgical pain in children and young people: prediction, prevention, and management
Williams, G., Howard, R. F., & Liossi, C. (2017) · PAIN Reports · doi:10.1097/pr9.0000000000000616 · Cited by 181 · see citing works
Trouvin, A., & Perrot, S. (2019) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2019.04.007 · Cited by 176 · see citing works
Diagnosis and assessment of neuropathic pain: The saga of clinical tools
Bouhassira, D., & Attal, N. (2010) · Pain · doi:10.1016/j.pain.2010.11.027 · Cited by 175 · see citing works
“Other research applications of the screening tools Screening tools have also been used to estimate the proportion of patients with NeP in patients with various conditions including diabetic neuropathy [77], back pain [28,45], postsurgical pain [67,70], Parkinson disease [37], and cancer [54].”
MethodDysautonomia and its underlying mechanisms in the hypermobility type of Ehlers-Danlos syndrome
De Wandele, I., Rombaut, L., Leybaert, L., Van de Borne, P., De Backer, T., Malfait, F., De Paepe, A., & Calders, P. (2014) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2013.12.006 · Cited by 168 · see citing works
“Further, 2 parts of the painDETECT questionnaire (PDQ) were used [35].”
MethodPhenotypic features of central sensitization
Williams, D. A. (2018) · Journal of Applied Biobehavioral Research · doi:10.1111/jabr.12135 · Cited by 180 · see citing works
Gwilym, S. E., Oag, H. C. L., Tracey, I., & Carr, A. J. (2011) · Journal of Bone and Joint Surgery - British Volume · doi:10.1302/0301-620x.93b4.25054 · Cited by 173 · see citing works
Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s)
Clauw, D. J. (2015) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2015.04.024 · Cited by 169 · see citing works
Raputová, J., Šrotová, I., Vlčková, E., Sommer, C., Üçeyler, N., Birklein, F., Rittner, H. L., Rebhorn, C., Adamová, B., Kovaľová, I., et al. (2017) · Pain · doi:10.1097/j.pain.0000000000001034 · Cited by 170 · see citing works
“All pDSPN patients reported descriptors typical of neuropathic pain.(6,15) In all cases, pain was present symmetrically and distally in the feet, and in some patients, also in the hands.”
Background
- Authors
- Freynhagen, R., Baron, R., Gockel, U., & Tölle, T. R.
- Affiliations
- Düsseldorf University Hospital (DE)
- University Hospital Schleswig-Holstein (DE)
- Pfizer (Germany) (DE)
- Technical University of Munich (DE)
- Corresponding author
- Freynhagen, Rainer
- Venue
- Current Medical Research and Opinion
- Publisher
- Informa UK Limited
- Published
- 2006-08-29
- Volume
- 22
- Issue
- 10
- Pages
- 1911-1920
- ISSN
- 0300-7995 (ISSN-L)
- 1473-4877
- OpenAlex
- W2154693681
- Cited by
- 2,280
- References
- 25
- Citations by year
- 2026: 158 · 2025: 182 · 2024: 187 · 2023: 177 · 2022: 172 · 2021: 179 · 2020: 149 · 2019: 121 · 2018: 161 · 2017: 128 · 2016: 130 · 2015: 99 · 2014: 99 · 2013: 102 · 2012: 68
- FWCI
- 12.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Current Medical Research and Opinion (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- neuropathic pain, low back pain, chronic pain, painDETECT questionnaire, screening questionnaire, prevalence, comorbidities, depression, anxiety, sleep disorders, pain intensity, quality of life, health care utilization, pain diagnosis
- MeSH terms
- Adult, Aged, Chronic Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Sensitivity and Specificity, Comorbidity, Low Back Pain
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