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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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MethodInfluentialSelf-citationPain in Parkinson disease: a cross-sectional survey of its prevalence, specifics, and therapy
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InfluentialAdvances and challenges in neuropathic pain: a narrative review and future directions
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BackgroundValidation of the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2) in Acute Low Back Pain
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Tools for Assessing Neuropathic Pain
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“One of these measures is the painDETECT [19], a self-report questionnaire with nine items that does not require a clinical examination.”
BackgroundEpidural Steroids, Etanercept, or Saline in Subacute Sciatica
Cohen, S. P., White, R. L., Kurihara, C., Larkin, T. M., Chang, A., Griffith, S. R., Gilligan, C. J., Larkin, R., Morlando, B., Pasquina, P. F., et al. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-8-201204170-00397 · Cited by 127
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“Distinguishing predominantly nociceptive LBP from neuropathic LBP can also be performed with the PainDETECT questionnaire, which has been shown to have significant sensibility/specificity to identify patients with a predominant neuropathic component to their LBP.(25,40) As the first category (A) concerns signs and sym…”
Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components
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“In order to identify NeuP in the community screening tools such as the Douleur Neuropathique en Quatre Questions (DN4) [8], Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) [5] and the painDETECT [20] have been developed.”
MethodReports of Chronic Pain in Childhood and Adolescence Among Patients at a Tertiary Care Pain Clinic
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Screening tools for neuropathic pain: Can they be of use in individuals with spinal cord injury?
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“Finally, the PD-Q has been validated in chronic lowback pain [12], and the pain pattern for that diagnosis may differ from pain related to SCI because chronic low-back pain is associated mainly with peripheral neuropathic pain from injured nerve roots.”
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“Higher scores indicate a larger likelihood of the presence of a neuropathic pain component [33].”
BackgroundPain and affective distress in arthritis: relationship to immunity and inflammation
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Identifying neuropathic back and leg pain: a cross-sectional study
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“Patients with neuropathic pain usually are more heavily burdened than patients with nociceptive pain and suffer more often from insomnia, anxiety, and depression.(1) Moreover, analgetic medication often has an insufficient effect on neuropathic pain.”
BackgroundChemotherapy-induced pain and neuropathy
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“In addition, the results obtained in this study were comparable with those obtained in previous studies [11,12].”
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“PainDETECT and S-LANSS performed well as classification questionnaires in previous studies (3,4) and categorized neuropathic pain in 27% and 30% of this sample, respectively.”
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“Eligible studies included only RCTs with: (1) patients with back or neck pain with or without radiculopathy; (2) a treatment group receiving epidural injections of corticosteroids or another analgesic; (3) a control group receiving either an epidural injection devoid of treatment drug or a nonepidural injection; and (…”
Pain in Fabry Disease: Practical Recommendations for Diagnosis and Treatment
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“The most notable are the Neuropathic Pain Symptom Inventory (NPSI) [35], the Neuropathic Pain Questionnaire (NPQ) [36], the DN4 questionnaire [37], the painDETECT questionnaire [38], the LANSS Pain Scale [39], and the ID Pain questionnaire [40].”
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“It has 85% sensitivity, 80% specificity, and 83% positive predictive value to differentiate neuropathic from non-neuropathic pain [18].”
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Self-citationChronic low back pain: pharmacological, interventional and surgical strategies
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Insufficient treatment of severe depression in neuromyelitis optica spectrum disorder
Chavarro, V. S., Mealy, M. A., Simpson, A. C., Lacheta, A., Pache, F. C., Ruprecht, K., Gold, S. M., Paul, F., Brandt, A. U., & Levy, M. (2016) · Neurology Neuroimmunology & Neuroinflammation · doi:10.1212/nxi.0000000000000286 · Cited by 110
“The PDQ was created to differentiate nociceptive from neuropathic pain in low back pain patients.(28) According to validation data representative of the German population,(26) a PDQ score of 12 or higher is indicative of pain with a primarily neuropathic etiology.”
MethodInoue, S., Taguchi, T., Yamashita, T., Nakamura, M., & Ushida, T. (2017) · European Journal of Pain · doi:10.1002/ejp.977 · Cited by 107
“The sensitivity and specificity of the clinical diagnosis are 85% and 80%, respectively (Freynhagen et al., 2006).”
BackgroundZolio, L., Lim, K. Y., McKenzie, J. E., Yan, M. K., Estee, M. M., Hussain, S. M., Cicuttini, F., & Wluka, A. E. (2021) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2021.03.021 · Cited by 106
Smith, J. G., Elias, L.-A., Yilmaz, Z., Barker, S., Shah, K., Shah, S., & Renton, T. F. (2013) · Journal of Orofacial Pain · doi:10.11607/jop.1056 · Cited by 105
Rethinking chronic pain in a primary care setting
Stanos, S. P., Brodsky, M., Argoff, C. E., Clauw, D. J., D’Arcy, Y. M., Donevan, S. D., Gebke, K. B., Jensen, M. P., Clark, E. L., McCarberg, B. H., et al. (2016) · Postgraduate Medicine · doi:10.1080/00325481.2016.1188319 · Cited by 107
Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities
Haanpää, M. L., Gourlay, G. K., Kent, J. L., Miaskowski, C. A., Raja, S. N., Schmader, K. E., & Wells, C. D. (2010) · Mayo Clinic Proceedings · doi:10.4065/mcp.2009.0645 · Cited by 106
Cancer-Related Neuropathic Pain
Edwards, H. L., Mulvey, M. R., & Bennett, M. (2019) · Cancers · doi:10.3390/cancers11030373 · Cited by 102
Qazi, Y., Hurwitz, S., Khan, S. A., Jurkunas, U. V., Dana, R., & Hamrah, P. (2016) · Ophthalmology · doi:10.1016/j.ophtha.2016.03.006 · Cited by 104
Christoph, A., Eerdekens, M., Kok, M., Volkers, G., & Freynhagen, R. (2017) · Pain · doi:10.1097/j.pain.0000000000000986 · Cited by 103
Self-citationModelling the prevalence and cost of back pain with neuropathic components in the general population
Schmidt, C. O., Schweikert, B., Wenig, C. M., Schmidt, U., Gockel, U., Freynhagen, R., Tölle, T. R., Baron, R., & Kohlmann, T. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2008.12.003 · Cited by 101
Self-citationDaniel, H. C., Narewska, J., Serpell, M. G., Hoggart, B., Johnson, R. W., & Rice, A. S. C. (2008) · European Journal of Pain · doi:10.1016/j.ejpain.2007.11.006 · Cited by 101
Cerimele, J. M., & Peccoralo, L. A. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-8-201204170-00002 · Cited by 100
Lluch, E., Nijs, J., Courtney, C. A., Rebbeck, T. J., Wylde, V., Baert, I. A. C., Wideman, T. H., Howells, N., & Skou, S. T. (2017) · Disability and Rehabilitation · doi:10.1080/09638288.2017.1358770 · Cited by 98
“In particular, two validated questionnaires have shown to be useful for measuring characteristics that indicate altered central nociceptive processing in patients with knee osteoarthritis: the Central Sensitization Inventory [63] and the (modified) painDETECT [64].”
BackgroundSpine-area pain in military personnel: a review of epidemiology, etiology, diagnosis, and treatment
Cohen, S. P., Gallagher, R. M., Davis, S. A., Griffith, S. R., & Carragee, E. J. (2011) · The Spine Journal · doi:10.1016/j.spinee.2011.10.010 · Cited by 100
Duloxetine and Subacute Pain after Knee Arthroplasty when Added to a Multimodal Analgesic Regimen
YaDeau, J. T., Brummett, C. M., Mayman, D. J., Lin, Y., Goytizolo, E. A., Padgett, D. E., Alexiades, M. M., Kahn, R. L., Jules-Elysee, K. M., Fields, K. G., et al. (2016) · Anesthesiology · doi:10.1097/aln.0000000000001228 · Cited by 98
Věchetová, G., Slovák, M., Kemlink, D., Hanzlíková, Z., Dušek, P., Nikolai, T., Růžička, E., Edwards, M. J., & Serranová, T. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.10.001 · Cited by 98
Axial Low Back Pain: One Painful Area – Many Perceptions and Mechanisms
Förster, M., Mahn, F., Gockel, U., Brosz, M., Freynhagen, R., Tölle, T. R., & Baron, R. (2013) · PLoS ONE · doi:10.1371/journal.pone.0068273 · Cited by 100
“The questionnaire was originally developed to identify neuropathic pain components and was validated in a cohort of patients that included lumbar back pain [17].”
BackgroundMethodResultInfluentialSelf-citationGervais-Hupé, J., Pollice, J., Sadi, J., & Carlesso, L. C. (2018) · Clinical Rheumatology · doi:10.1007/s10067-018-4279-8 · Cited by 97
Elsig, S., Luomajoki, H. A., Sattelmayer, M., Taeymans, J., Tal‐Akabi, A., & Hilfiker, R. (2014) · Manual Therapy · doi:10.1016/j.math.2014.05.014 · Cited by 97
Is tapentadol different from classical opioids? A review of the evidence
Langford, R., Knaggs, R., Farquhar-Smith, P. W., & Dickenson, A. H. (2016) · British Journal of Pain · doi:10.1177/2049463716657363 · Cited by 96
Clinical outcome assessment in clinical trials of chronic pain treatments
Patel, K. V., Amtmann, D., Jensen, M. P., Smith, S. M., Veasley, C., & Turk, D. C. (2021) · PAIN Reports · doi:10.1097/pr9.0000000000000784 · Cited by 100
Neuropathic pain: diagnosis and treatment
Magrinelli, F., Zanette, G., & Tamburin, S. (2013) · Practical Neurology · doi:10.1136/practneurol-2013-000536 · Cited by 96
Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain
Dean, B. J. F., Gwilym, S. E., & Carr, A. J. (2013) · British Journal of Sports Medicine · doi:10.1136/bjsports-2012-091492 · Cited by 103
van Helvoort, E. M., van Spil, W. E., Jansen, M. P., Welsing, P. M. J., Kloppenburg, M., Loef, M., Blanco, F. J., Haugen, I. K., Berenbaum, F., Bacardit, J., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035101 · Cited by 94
Fishbain, D. A., Cole, B., Lewis, J. E., & Gao, J. (2013) · Pain Medicine · doi:10.1111/pme.12229 · Cited by 94
Cultural Adaptation and Validation of the painDETECT Scale Into Spanish
Andrés, J. A. D., Pérez‐Cajaraville, J., López-Alarcon, M. D., López‐Millán, J. M., Margarit, C., Rodrigo-Royo, M. D., Gay, M. L. F., Abejón, D., Ruiz, M. Á., López-Gómez, V., et al. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31822bb35b · Cited by 93
“4% of full functionality in everyday duties, and only 24% of patients kept optimal sleep quality.(27) The original authors also report that 64% of patients not presenting NP diagnosis will meet criteria for a depression diagnose in their epidemiologic survey, whereas depression prevalence will rise to 92% when NP is p…”
BackgroundSpinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications
Dones, I., & Levi, V. (2018) · Brain Sciences · doi:10.3390/brainsci8080138 · Cited by 94
Smart, K. M., Blake, C. M., Staines, A. S., Thacker, M. A., & Doody, C. (2012) · Manual Therapy · doi:10.1016/j.math.2012.03.002 · Cited by 93
“…a feature in a number of neuropathic screening instruments, including the ‘Standardised Evaluation of Pain’ (StEP) (Scholz et al., 2009), ‘painDETECT’ (Freynhagen et al., 2006), ‘Douleur Neuropathique 4’ (Bouhassira et al., 2005), ‘Neuropathic Pain Questionnaire’ (Krause and Backonja, 2003) and…”
Amris, K., Jespersen, A., & Bliddal, H. (2010) · Pain · doi:10.1016/j.pain.2010.08.023 · Cited by 92
“The painDETECT questionnaire was originally developed and validated for diagnostic purposes in cooperation with the German Research Network on Neuropathic Pain [9] and has been translated into 19 different languages, including Danish.”
MethodInfluentialFactors Associated With Vulvodynia Incidence
Reed, B. D., Legocki, L. J., Plegue, M. A., Sen, A., Haefner, H. K., & Harlow, S. D. (2014) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000000066 · Cited by 92
Linguistic validation of the DN4 for use in international studies
van Seventer, R., Vos, C., Meerding, W. J., Mear, I., Gal, M. L., Bouhassira, D., & Huygen, F. J. P. M. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2009.01.005 · Cited by 91
Sommer, C., Richter, H., Rogausch, J. P., Frettlöh, J., Lungenhausen, M., & Maier, C. (2011) · BMC Neurology · doi:10.1186/1471-2377-11-104 · Cited by 90
“These include the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS [2]), the Neuropathic Pain Questionnaire [3], the DN4 [4], the painDETECT questionnaire [5], and the ID pain [6].”
MethodRombaut, L., Scheper, M., De Wandele, I., De Vries, J., Meeus, M., Malfait, F., Engelbert, R., & Calders, P. (2015) · Clinical Rheumatology · doi:10.1007/s10067-014-2499-0 · Cited by 91
“With a total score of 13–18, the presence of neuropathic pain is ambiguous [22].”
BackgroundNeuropathic Features of Joint Pain: A Community‐Based Study
Soni, A., Batra, R. N., Gwilym, S. E., Spector, T. D., Hart, D. J., Arden, N., Cooper, C. C., Tracey, I., & Javaid, M. K. (2013) · Arthritis & Rheumatism · doi:10.1002/art.37962 · Cited by 89
Howard, R. F., Wiener, S., & Walker, S. M. (2013) · Archives of Disease in Childhood · doi:10.1136/archdischild-2013-304208 · Cited by 89
“, 2005); NPQ, Neuropathic Pain Questionnaire (Krause and Backonja, 2003); painDETECT (Freynhagen et al., 2006); ID-Pain, identify Pain (Portenoy, 2006).”
BackgroundTranslational neuropathic pain research: A clinical perspective
Bouhassira, D., & Attal, N. (2016) · Neuroscience · doi:10.1016/j.neuroscience.2016.03.029 · Cited by 89
Brines, M. L., Culver, D. A., Ferdousi, M., Tannemaat, M. R., van Velzen, M., Dahan, A., & Malik, R. A. (2018) · Scientific Reports · doi:10.1038/s41598-018-23107-w · Cited by 88
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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