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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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“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]
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“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]
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“The 9-item PainDETECT questionnaire [15], which was developed to identify pain of a neuropathic origin, is scored from 1 to 38, with a score612 indicating that a neuropathic component is unlikely and a score of P19 indicating that a neuropathic component is likely.”
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Self-citationA Comprehensive Algorithm for Management of Neuropathic Pain
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Bouhassira, D. (2018) · Revue Neurologique · doi:10.1016/j.neurol.2018.09.016 · Cited by 409
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“DSPN; 2) the neuropathic pain symptom inventory (27), which evaluates the different symptoms and dimensions of neuropathic pain; 3) the neuropathic pain questionnaire (28), which consists of 12 items, including 10 related to sensations and or sensory responses and 2 related to affect; 4) the LANNS pain scale (29), whi…”
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MethodSelf-citationThe Pain in Neuropathy Study (PiNS)
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“painDETECT 2 (0-6) 12 (7-17)* 18 (11-23)†‡ ,0.”
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“The importance of a better description of neuropathic pain by means of self-reported questionnaires like DN4 180 and PainDETECT 181 , which report on pain sensitivity and neuropathic-like pain, remains unclear, as is the impact and optimal technique of preoperative peripheral nerve blocks.”
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Peripheral input and its importance for central sensitization
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Self-citationEpidemiology of Neuropathic Pain and Its Impact on Quality of Life
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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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“for neuropathic pain [45–47], the DN4 relies largely on a structured exploration of the patient’s history.”
BackgroundOnly Half of the Chronic Pain After Thoracic Surgery Shows a Neuropathic Component
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“PainDETECT in patients with chronic lower back pain (neuropathic) [140]; and the Revised Fibromyalgia Impact”
BackgroundCancer Pain Assessment and Classification
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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 267
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“Low back pain may have both nociceptive and neuropathic pain components [1,62,63].”
BackgroundOsteoarthritis pain: nociceptive or neuropathic?
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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
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Pregabalin Reduces Pain in Patients With Chronic Pancreatitis in a Randomized, Controlled Trial
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Composite Pain Biomarker Signatures for Objective Assessment and Effective Treatment
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“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).”
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Primary afferent input critical for maintaining spontaneous pain in peripheral neuropathy
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“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
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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
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 224
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
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 237
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
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
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
“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
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
“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
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
“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
“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
“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
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 236
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
“, 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
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 205
“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
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 204
“…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
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
“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
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
Self-citationSmart, K. M., Blake, C. M., Staines, A. S., & Doody, C. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318215f16a · Cited by 191
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
Fonoff, E. T. (2012) · Pain Physician · doi:10.36076/ppj.2012/15/e115 · Cited by 183
Cohen, S. P., Argoff, C. E., & Carragee, E. J. (2008) · BMJ · doi:10.1136/bmj.a2718 · Cited by 183
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
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
Trouvin, A., & Perrot, S. (2019) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2019.04.007 · Cited by 176
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
“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
“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
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
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
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
“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
Metadata
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Physiology (medical) › 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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