Cited by 2,280Musculoskeletal pain and rehabilitationPain Mechanisms and TreatmentsPain Management and Treatment

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pain DETECT : a new screening questionnaire to identify neuropathic components in patients with back pain

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Freynhagen, Rainer, Baron, Ralf, Gockel, Ulrich, Tölle, Thomas R.·2006·Current Medical Research and Opinion

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Abstract

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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Method
Development of a complex intervention for people with chronic pain after knee replacement: the STAR care pathway
Wylde, V., Howells, N., Bertram, W., Moore, A. J., Bruce, J., McCabe, C., Blom, A. W., Dennis, J. A., Burston, A., & Gooberman‐Hill, R. (2018) · Trials · doi:10.1186/s13063-017-2391-8 · Cited by 28
“Patient-completed questionnaires include the Brief Pain Inventory [25], Hospital Anxiety and Depression Scale [26], PainDETECT [27] and Douleur Neuropathique 4 [28].”
Method
The Effect of Neuropathic Pain Symptoms on Remission in Patients with Early Rheumatoid Arthritis
Salaffi, F., Carlo, M. D., Carotti, M., & Sarzi‐Puttini, P. (2018) · Current Rheumatology Reviews · doi:10.2174/1573397114666180806142814 · Cited by 27
Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society – Part one
Szczudlik, A., Dobrogowski, J., Wordliczek, J., Stępień, A., Krajnik, M., Leppert, W., Woroń, J., Przeklasa-Muszyńska, A., Kocot-Kępska, M., Zajączkowska, R., et al. (2014) · Neurologia i Neurochirurgia Polska · doi:10.1016/j.pjnns.2014.07.011 · Cited by 27
Neuroinflammatory activation in sensory and motor regions of the cortex is related to sensorimotor function in individuals with low back pain maintained by nociplastic mechanisms: A preliminary proof‐of‐concept study
Shraim, M. A., Massé‐Alarie, H., Farrell, M. J., Cavaleri, R., Loggia, M. L., & Hodges, P. W. (2024) · European Journal of Pain · doi:10.1002/ejp.2313 · Cited by 29
Clinical Phenotypes of Diabetic Peripheral Neuropathy: Implications for Phenotypic-Based Therapeutics Strategies
Lee, J.-E., & Won, J. C. (2025) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2025.0299 · Cited by 37
“3) The painDETECT questionnaire This questionnaire was developed specifically to detect neuropathic pain components in adult patients with low back pain [34].”
A retrospective analysis of the long-term test–retest stability of pain descriptors of the painDETECT questionnaire
Keller, T., Freynhagen, R., Tölle, T. R., Liwowsky, I., Möller, P., Hüllemann, P., Gockel, U., Stemmler, E., & Baron, R. (2015) · Current Medical Research and Opinion · doi:10.1185/03007995.2015.1125869 · Cited by 26
Self-citation
Is early postoperative administration of pregabalin beneficial for patients with lung cancer?—randomized control trial
Miyazaki, T., Sakai, T., Sato, S., Yamasaki, N., Tsuchiya, T., Matsumoto, K., Kamohara, R., Hatachi, G., Doi, R., & Nagayasu, T. (2016) · Journal of Thoracic Disease · doi:10.21037/jtd.2016.12.04 · Cited by 26
“PDQ characteristics are shown elsewhere (17,18) but comprise three components.”
BackgroundMethod
Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy
Elsesser, K., & Cegla, T. H. (2017) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2017.07.005 · Cited by 26
The added value of bedside examination and screening QST to improve neuropathic pain identification in patients with chronic pain
Timmerman, H., Wilder‐Smith, O. H. G., Steegers, M. A. H., Vissers, K. C. P., & Wolff, A. P. (2018) · Journal of Pain Research · doi:10.2147/jpr.s154698 · Cited by 26
“30,31 The PainDETECT 32 and the DN4 33 were both developed to screen for the presence of neuropathic pain.”
Joint Line Modification in Kinematically Aligned Total Knee Arthroplasty Improves Functional Activity but Not Patient Satisfaction
Niki, Y., Kobayashi, S., Nagura, T., Udagawa, K., & Harato, K. (2018) · The Journal of Arthroplasty · doi:10.1016/j.arth.2018.02.015 · Cited by 26
Assessing neuropathic pain in patients with low back‐related leg pain: Comparing the painDETECT Questionnaire with the 2016 NeuPSIG grading system
Hasvik, E., Haugen, A. J., Gjerstad, J., & Grøvle, L. (2018) · European Journal of Pain · doi:10.1002/ejp.1204 · Cited by 27
Neuropathic-Like Pain Symptoms in a Community-Dwelling Sample with or at Risk for Knee Osteoarthritis
Terry, E. L., Booker, S. Q., Cardoso, J. S., Sibille, K. T., Bartley, E. J., Glover, T. L., Vaughn, I. A., Thompson, K. A., Bulls, H. W., Addison, A., et al. (2019) · Pain Medicine · doi:10.1093/pm/pnz112 · Cited by 26
Acupuncture for Fibromyalgia: An Open‐Label Pragmatic Study on Effects on Disease Severity, Neuropathic Pain Features, and Pain Catastrophizing
Carlo, M. D., Beci, G., & Salaffi, F. (2020) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2020/9869250 · Cited by 27
“Scores between 13 and 18 are defined as an ambiguous result [21].”
Background
Pain assessment in Indian Parkinson's Disease patients using King's Parkinson's Disease pain scale
Behari, M., Srivastava, A., Achtani, R., Nandal, N., & Dutta, R. B. (2020) · Annals of Indian Academy of Neurology · doi:10.4103/aian.aian_449_20 · Cited by 26
“[8] These include unified Parkinson’s disease rating scale (UPDRS), visual analog scale, brief pain inventory,[9] McGill pain questionnaire,[10] DoPaMiP study questionnaire (Douleur et maladie de Parkinson en Midi‐Pyrénées),[8] Marburg‐São Paulo‐Créteil questionnaire,[11] Douleur Neuropathique questionnaire (DN‐4),[12…”
Method
High Rate of Pain Sensitization in Musculoskeletal Shoulder Diseases
Previtali, D., Bordoni, V., Filardo, G., Marchettini, P., Guerra, E., & Candrian, C. (2021) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000914 · Cited by 26
Contemporary management of pain in cirrhosis: Toward precision therapy for pain
Holman, A., Parikh, N. D., Clauw, D. J., Williams, D. A., & Tapper, E. B. (2022) · Hepatology · doi:10.1002/hep.32598 · Cited by 26
“[129] Multiple screening tools have been developed to help identify patients with neuropathic pain, such as the Neuropathic Pain Questionnaire[141] and painDETECT,[142] that include items related to symptoms/signs and may be used as diagnostic aids.”
Method
Perception threshold tracking: validating a novel method for assessing function of large and small sensory nerve fibers in diabetic peripheral neuropathy with and without pain
Røikjer, J., Croosu, S. S., Frøkjær, J. B., Hansen, T. M., Arendt‐Nielsen, L., Ejskjær, N., & Mørch, C. D. (2022) · Pain · doi:10.1097/j.pain.0000000000002780 · Cited by 28
Prevalence and Determinants of Chronic Pain Post-COVID; Cross-Sectional Study
Zis, P., Ioannou, C., Artemiadis, A., Christodoulou, K., Kalampokini, S., & Hadjigeorgiou, G. M. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195569 · Cited by 26
“The painDETECT questionnaire [5] was used to map the location(s) of pain.”
Method
EEG frequency band analysis in chronic neuropathic pain: A linear and nonlinear approach to classify pain severity
Zolezzi, D. M., Alonso-Valerdi, L. M., & Ibarra-Zárate, D. I. (2023) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2023.107349 · Cited by 28
Lidocaine 5 % patches as an effective short-term co-analgesic in cancer pain. Preliminary results
Garzón-Rodríguez, C., Merchán, M. C., Calsina-Berna, A., López-Rómboli, E., & Porta-Sales, J. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1948-7 · Cited by 26
“There had to be a neuropathic component plus allodynia, with a PainDETECT score >18 [18].”
Background
An exploratory study on the effectiveness of “Calmare therapy” in patients with cancer-related neuropathic pain: A pilot study
Lee, S. C., Park, K. S., Moon, J. Y., Kim, E. J., Kim, Y. C., Seo, H.-J., Sung, J. K., & Lee, D. J. (2015) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2015.12.001 · Cited by 26
“…consisting of seven weighted sensory descriptor items and two items relating to the radiating and temporal characteristics of the patient's pain pattern (Freynhagen et al., 2006); 4) patients whose cancer-related neuropathic pain had continued for 6 months but had been stable for at least 2…”
BackgroundMethod
Neuropathic pain may be common in chronic lower limb tendinopathy: a prospective cohort study
Wheeler, P. C. (2016) · British Journal of Pain · doi:10.1177/2049463716680560 · Cited by 26
Measurement properties of painDETECT: Rasch analysis of responses from community-dwelling adults with neuropathic pain
Packham, T., Cappelleri, J. C., Sadosky, A., MacDermid, J. C., & Brunner, F. (2017) · BMC Neurology · doi:10.1186/s12883-017-0825-2 · Cited by 26
“[4] The US English version of this tool has been employed to evaluate populations including osteoarthritis [5, 6], rheumatoid arthritis [7, 8], amyotrophic lat-”
BackgroundMethodInfluential
The addition of a tension night splint to a structured home rehabilitation programme in patients with chronic plantar fasciitis does not lead to significant additional benefits in either pain, function or flexibility: a single-blinded randomised controlled trial
Wheeler, P. C. (2017) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2017-000234 · Cited by 26
“51 The painDETECT questionnaire was originally developed for the assessment of patients with chronic low back pain and has high sensitivity, specificity and positive predictive value for the presence of neuropathic pain in a prospective multicentre trial.(52) Following this the questionnaire has been used in a wide ra…”
Method
Fourteen days of etoricoxib 60 mg improves pain, hyperalgesia and physical function in individuals with knee osteoarthritis: a randomized controlled trial
Moss, P., Benson, H. A., Will, R., & Wright, A. (2017) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2017.07.009 · Cited by 26
Up-date on Clinical Management of Postherpetic Neuralgia and Mechanism-Based Treatment: New Options in Therapy
Forstenpointner, J., Rice, A. S. C., Finnerup, N. B., & Baron, R. (2018) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiy381 · Cited by 26
Self-citation
The Relationship Between Neuropathic Pain and Spinal Alignment
Imagama, S., Ando, K., Kobayashi, K., Seki, T., Hamada, T., Machino, M., Ota, K., Tanaka, S. A., Morozumi, M., Kanbara, S., et al. (2019) · Spine · doi:10.1097/brs.0000000000003073 · Cited by 26
Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back related leg pain: a systematic review and narrative synthesis
Mistry, J., Heneghan, N. R., Noblet, T., Falla, D., & Rushton, A. (2020) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-020-03436-6 · Cited by 26
The Role of Angina Pectoris in Chronic Pain After Coronary Artery Bypass Graft Surgery
Steegers, M. A. H., van de Luijtgaarden, A. C. M., Noyez, L., Scheffer, G., & Wilder‐Smith, O. H. G. (2007) · Journal of Pain · doi:10.1016/j.jpain.2007.04.007 · Cited by 26
Unraveling Osteoarthritis: Mechanistic Insights and Emerging Therapies Targeting Pain and Inflammation
Alad, M., Yousef, F., Epure, L. M., Lui, A., Grant, M. P., Merle, G. E., Eliopoulos, N., Barralet, J. E., Antoniou, J., & Mwale, F. (2025) · Biomolecules · doi:10.3390/biom15060874 · Cited by 30
Pregabalin in Neuropathic Pain Related to DPN, Cancer and Back Pain: Analysis of a 6-Week Observational Study
Toelle, T. R., Varvara, R., Nimour, M., Emir, B., & Brasser, M. (2012) · The Open Pain Journal · doi:10.2174/1876386301205010001 · Cited by 25
Content validity of the comprehensive international classification of functioning, disability and health (ICF) core set for low back pain from the perspective of physicians: a Delphi survey
Glocker, C., Kirchberger, I., Gläßel, A., Fincziczki, A., Stucki, G., & Cieza, A. (2012) · Chronic Illness · doi:10.1177/1742395312451280 · Cited by 26
“In an unselected cohort of chronic LBP patients, 37% were found to have predominantly neuropathic pain.(36) Since neuropathic pain correlates with more intense pain, more severe co-morbidity and poorer quality of life than nociceptive pain,(36) it seems to be necessary to have an adequate representation in the ICF.”
Background
Frequency and features of the central poststroke pain
Vukojević, Z., Dominović-Kovačević, A., Perić, S., Grgić, S., Bjelica, B., Basta, I. Z., & Lavrnić, D. (2018) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2018.06.004 · Cited by 25
Evaluation of the Neuropathic Component of Chronic Low Back Pain
Andrašinová, T., Kalíková, E., Kopáčik, R., Šrotová, I., Vlčková, E., Dušek, L., Bednařík, J., & Adamová, B. (2018) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000653 · Cited by 24
Short-term outcomes of mirogabalin in patients with peripheral neuropathic pain: a retrospective study
Tetsunaga, T., Tetsunaga, T., Nishida, K., Misawa, H., Takigawa, T., Yamane, K., Tsuji, H., Takei, Y., & Ozaki, T. (2020) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-020-01709-3 · Cited by 25
Painful metaphors: enactivism and art in qualitative research
Stilwell, P., Stilwell, C. L., Sabo, B., & Harman, K. (2020) · Medical Humanities · doi:10.1136/medhum-2020-011874 · Cited by 30
“Rainer Freynhagen et al. (2006)., “PainDETECT: A New Screening Questionnaire to”
Background
Measuring Outcomes in Axial Spondyloarthritis
Ogdie, A., Duarte‐García, A., Hwang, M. C., Navarro‐Compán, V., van der Heijde, D. M. F. M., & Mease, P. J. (2020) · Arthritis Care & Research · doi:10.1002/acr.24266 · Cited by 26
Optimizing management of low back pain through the pain and disability drivers management model: A feasibility trial
Longtin, C., Décary, S., Cook, C. E., Martel, M. O., Lafrenaye, S., Carlesso, L. C., Naye, F., & Tousignant‐Laflamme, Y. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245689 · Cited by 28
“Nervous system dysfunction (NSD) drivers Radicular signs/symptoms, hyperalgesia/ allodynia, evidence of central sensitization The PainDetect Questionnaire [24] is a reliable screening tool to predict the likelihood of a neuropathic pain component.”
Method
Development of a bedside tool-kit for assessing sensitization in patients with chronic osteoarthritis knee pain or chronic knee pain after total knee replacement
Sachau, J., Otto, J. C., Kirchhofer, V., Larsen, J. B., Kennes, L. N., Hüllemann, P., Arendt‐Nielsen, L., & Baron, R. (2021) · Pain · doi:10.1097/j.pain.0000000000002335 · Cited by 25
“Furthermore, sensitization characteristics in chronic musculoskeletal pain such as chronic low back pain and osteoarthritis can most likely to some degree be captured [16,19].”
BackgroundSelf-citation
Comparison of the Effectiveness and Tolerability of Nabiximols (THC:CBD) Oromucosal Spray versus Oral Dronabinol (THC) as Add-on Treatment for Severe Neuropathic Pain in Real-World Clinical Practice: Retrospective Analysis of the German Pain e-Registry
Ueberall, M. A., Essner, U., Silván, C. V., & Mueller-Schwefe, G. H. (2022) · Journal of Pain Research · doi:10.2147/jpr.s340968 · Cited by 25
“Mean relative change (improvement) rates at the end of week 24 for each ASR-9 component were significantly greater (all p 0.001) for patients treated with NBX (Figure 3A) than DRO (Figure 3B): 83.4 vs 75.9% for PIX, 76.0 vs 68.3% for mPDI, 27.8 vs 20.7% for VR12-PCS, 24.7 vs 18.4% for VR12-MCS, 64.1 vs 51.3% for MFHW,…”
MethodInfluential
Chronic pain precedes disrupted eating behavior in low-back pain patients
Lin, Y., de Araújo, I. E., Stanley, G., Small, D. M., & Geha, P. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263527 · Cited by 25
Self‐reported sensory descriptors are associated with quantitative sensory testing parameters in patients with cervical radiculopathy, but not in patients with fibromyalgia
Tampin, B., Briffa, K., & Slater, H. (2012) · European Journal of Pain · doi:10.1002/j.1532-2149.2012.00227.x · Cited by 24
“Similarly, Maier et al. (2010) documented in 1236 patients with NeP that for some patients, a sensory loss was the only presenting sensory abnormality.”
BackgroundMethodInfluential
A Randomized Controlled Trial to Assess Pain and Magnetic Resonance Imaging-Based (MRI-Based) Structural Spine Changes in Low Back Pain Patients After Yoga Practice
Telles, S., Bhardwaj, A. K., Gupta, R. K., Sharma, S. K., Monro, R., & Balkrishna, A. (2016) · Medical Science Monitor · doi:10.12659/msm.896599 · Cited by 25
“Cases of disc herniation may undergo improvement in symptoms with spontaneous resolution of the LBP but 37–50% persist for 12 or more months [1,4].”
Background
Plasma N-glycome composition associates with chronic low back pain
Trbojević‐Akmačić, I., Vučković, F., Vilaj, M. Ć., Skelin, A., Karssen, L. C., Krištić, J., Jurić, J., Momčilović, A., Šimunović, J., Mangino, M., et al. (2018) · Biochimica et Biophysica Acta (BBA) - General Subjects · doi:10.1016/j.bbagen.2018.07.003 · Cited by 25
Pain-Related Fear—Dissociable Neural Sources of Different Fear Constructs
Meier, M. L., Vrana, A., Humphreys, B. K., Seifritz, E., Stämpfli, P., & Schweinhardt, P. (2018) · eNeuro · doi:10.1523/eneuro.0107-18.2018 · Cited by 26
“imaginable pain” to assess current pain, strongest and average pain intensity in the previous 4 weeks (Freynhagen et al., 2006).”
Background
A narrative review of data collection and analysis guidelines for comparative effectiveness research in chronic pain using patient-reported outcomes and electronic health records
Dressler, A. M., Gillman, A. G., & Wasan, A. D. (2019) · Journal of Pain Research · doi:10.2147/jpr.s184023 · Cited by 25
“Additionally, there are other validated measures available that provide an alternative and/or supplement to the PROMIS measures, including the Brief Pain Inventory,(20) the Oswestry Disability Index,(21) and the PainDETECT Questionnaire for Neuropathic Pain.(22) When choosing which measures to include in a PRO databas…”
Method
Efficacy and safety of cannabidiol followed by an open label add-on of tetrahydrocannabinol for the treatment of chronic pain in patients with rheumatoid arthritis or ankylosing spondylitis: protocol for a multicentre, randomised, placebo-controlled study
Hendricks, O., Andersen, T. E., Christiansen, A. A., Primdahl, J., Hauge, E., Ellingsen, T., Horsted, T. I., Bachmann, A. G., Loft, A. G., Bojesen, A. B., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028197 · Cited by 31

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
ORCID: Freynhagen, Rainer
Baron, Ralf
Tölle, Thomas R.
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
DOI: 10.1185/030079906x132488
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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pain DETECT : a new screening questionnaire to identify neuropathic components in patients with back pain

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