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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“Prior to the experiment, the patients with CLBP completed two questionnaires; the German version of the Roland-Morris Disability questionnaire (Wiesinger et al., 1999), which grades physical disability in everyday life activities, and the Pain Detect Inventory (Freynhagen et al., 2006) in order to assess pain quantity…”
BackgroundMethodInfluential
Testing the validity and reliability of the Arabic version of the painDETECT questionnaire in the assessment of neuropathic pain
Abu-Shaheen, A. K., Yousef, S., Riaz, M. A., Nofal, A., AlFayyad, I., Khan, S. M., & Heena, H. (2018) · PLoS ONE · doi:10.1371/journal.pone.0194358 · Cited by 22
Lidocaine medicated plaster, an additional potential treatment option for localized post-surgical neuropathic pain: efficacy and safety results of a randomized, placebo-controlled trial
Palladini, M. C., Boesl, I., Koenig, S., Buchheister, B., & Attal, N. (2019) · Current Medical Research and Opinion · doi:10.1080/03007995.2019.1565709 · Cited by 23
Small Fiber Neuropathy: Clinicopathological Correlations
Pál, E., Fülöp, K., Tóth, P., Deli, G., Pfund, Z., Janszky, J., & Komoly, S. (2020) · Behavioural Neurology · doi:10.1155/2020/8796519 · Cited by 22
Positional changes in lumbar disc herniation during standing or lumbar extension: a cross-sectional weight-bearing MRI study
Nordberg, C. L., Boesen, M., Fournier, G. L., Bliddal, H., Hansen, P., & Hansen, B. B. (2020) · European Radiology · doi:10.1007/s00330-020-07132-w · Cited by 22
“The overall pain level was measured on an ordinal 11-point numerical rating scale (NRS: 0 = no LBP; 10 = worst LBP possible), and the patients had to fill in the 13-item Pain-Detect Questionnaire (PDQ) to identify any neuropathic component [9].”
Method
Duloxetine in OsteoArthritis (DOA) study: effects of duloxetine on pain and function in end-stage hip and knee OA – a pragmatic enriched randomized controlled trial
Blikman, T., Rienstra, W., van Raaij, T. M., ten Hagen, A. J., Dijkstra, B., Zijlstra, W. P., Bulstra, S. K., Stevens, M. J., & van den Akker‐Scheek, I. (2022) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-05034-0 · Cited by 24
Clinical Phenotyping for Pain Mechanisms in Urologic Chronic Pelvic Pain Syndromes: A MAPP Research Network Study
Schrepf, A., Gallop, R., Naliboff, B. D., Harte, S. E., Afari, N., Lai, H. H., Pontari, M. A., McKernan, L. C., Strachan, E. D., Kreder, K. J., et al. (2022) · Journal of Pain · doi:10.1016/j.jpain.2022.03.240 · Cited by 22
Multi-Site Observational Study to Assess Biomarkers for Susceptibility or Resilience to Chronic Pain: The Acute to Chronic Pain Signatures (A2CPS) Study Protocol
Berardi, G., Frey‐Law, L., Sluka, K. A., Bayman, E. O., Coffey, C. S., Ecklund, D. J., Vance, C. G. T., Dailey, D. L., Burns, J. W., Buvanendran, A., et al. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.849214 · Cited by 25
Recent Progress in Gels for Neuropathic Pain
Pușcașu, C., Zanfirescu, A., & Negreș, S. (2023) · Gels · doi:10.3390/gels9050417 · Cited by 25
“In patients with chronic neuropathic pain, physical and mental health declines more than in those with other types of chronic pain [9,10].”
Background
Satisfaction with daily occupations amongst asylum seekers in Denmark
Morville, A.-L., Erlandsson, L., Danneskiold‐Samsøe, B., Amris, K., & Eklund, M. (2015) · Scandinavian Journal of Occupational Therapy · doi:10.3109/11038128.2014.982702 · Cited by 22
“In order to assess the likelihood of neuropathic pain, the Pain Detect Questionnaire (PDQ) was used (25).”
Central Pain Processing in Osteoarthritis: Implications for Treatment
Hassan, H. M. J., & Walsh, D. A. (2013) · Pain Management · doi:10.2217/pmt.13.64 · Cited by 22
Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis: protocol for a prospective, exploratory cohort study
Højgaard, P., Christensen, R., Dreyer, L., Mease, P. J., de Wit, M. P. T., Skov, L., Glintborg, B., Christensen, A. W., Ballegaard, C., Bliddal, H., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010650 · Cited by 22
“For screening purposes, PDQ cut-off scores ≤12 (a neuropathic component is unlikely) and ≥19 (a neuropathic component is likely) have been found to be appropriate.(46) Table 1 PRP involvement according to EULAR”
BackgroundMethod
Pain sensitivity in patients with haemophilia following moderate aerobic exercise intervention
Krüger, S., Weitz, C., Runkel, B., & Hilberg, T. (2016) · Haemophilia · doi:10.1111/hae.13016 · Cited by 22
It just feels weird!: a qualitative study of how children aged 10–18 years describe neuropathic pain
Yeung, K.-K., Engle, L., Rabel, A., Adamson, K., Schwellnus, H., & Evans, C. M. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1207107 · Cited by 22
“Although validated adult NP screening tools exist, including the Douleur Neuropathique 4 (DN4),[3] Leeds Assessment of Neuropathic Symptoms and Signs (LANSS),[2] the Neuropathic Pain Questionnaire (NPQ),[24] the painDETECT,[25] and ID Pain,[26] none are validated for use with children.”
Method
The nature of osteoporotic low back pain without acute vertebral fracture: A prospective multicenter study on the analgesic effect of monthly minodronic acid hydrate
Fujimoto, K., Inage, K., Orita, S., Yamashita, M., Abe, K., Yamagata, M., Sainoh, T., Akazawa, T., Kinoshita, T., Nemoto, T., et al. (2017) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2017.01.022 · Cited by 22
Spinal Cord Injury Pain Instrument and pain DETECT questionnaire: Convergent construct validity in individuals with Spinal Cord Injury
Franz, S., Schuld, C., Wilder-Smith, E. P., Heutehaus, L., Lang, S., Gantz, S., Schuh‐Hofer, S., Treede, R., Bryce, T. N., Wang, H., et al. (2017) · European Journal of Pain · doi:10.1002/ejp.1069 · Cited by 22
“The initial creation of items for both screening tools, SCIPI and PDQ, was realized according to official guidelines and based on advice from associations, societies or state of the art expert statements in the field of pain research (Freynhagen et al., 2006; Bryce et al., 2014).”
BackgroundMethodInfluential
Complex Regional Pain Syndrome after Total Knee Arthroplasty is Rare and Misdiagnosis Potentially Hazardous—Prospective Study of the New Diagnostic Criteria in 100 Patients with No Cases Identified
Kosy, J. D., Middleton, S., Bradley, B., Stroud, R., Phillips, J., & Toms, A. D. (2018) · The Journal of Knee Surgery · doi:10.1055/s-0037-1615746 · Cited by 25
The course of pain hypersensitivity according to painDETECT in patients with rheumatoid arthritis initiating treatment: results from the prospective FRAME-cohort study
Rifbjerg-Madsen, S., Christensen, A. W., Boesen, M., Christensen, R., Danneskiold‐Samsøe, B., Bliddal, H., Dreyer, L., Locht, H., & Amris, K. (2018) · Arthritis Research & Therapy · doi:10.1186/s13075-018-1581-4 · Cited by 22
Investigation of the Correlation between Postherpetic Itch and Neuropathic Pain over Time
Ishikawa, R., Iseki, M., Koga, R., & Inada, E. (2018) · Pain Research and Management · doi:10.1155/2018/9305126 · Cited by 22
painDETECT Questionnaire
Mathieson, S., & Lin, C. (2013) · Journal of physiotherapy · doi:10.1016/s1836-9553(13)70189-9 · Cited by 22
Moderators and mediators of effects of unloading shoes on knee pain in people with knee osteoarthritis: an exploratory analysis of the SHARK randomised controlled trial
Paterson, K. L., Kasza, J., Bennell, K. L., Wrigley, T. V., Metcalf, B., Campbell, P. K., Hunter, D. J., & Hinman, R. S. (2017) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2017.11.002 · Cited by 22
Drug dependence in patients with chronic pain
Tetsunaga, T., Tetsunaga, T., Nishida, K., Kanzaki, H., Misawa, H., Takigawa, T., Shiozaki, Y., & Ozaki, T. (2018) · Medicine · doi:10.1097/md.0000000000012748 · Cited by 22
“Both neuropathic and nociceptive pain mechanisms are associated with chronic low back pain (LBP).([2,3]) Neuropathic pain patients show higher levels of pain intensity accompanied by more comorbidities such”
Background
Usefulness of the DN4, S-LANSS, and painDETECT screening questionnaires to detect the neuropathic pain components in people with acute whiplash-associated disorders: a cross-sectional study
Ríos‐León, M., Taylor, J., Segura‐Fragoso, A., & Barriga-Martín, A. (2023) · Pain Medicine · doi:10.1093/pm/pnad165 · Cited by 21
Transcutaneous vagus nerve stimulation as a pain modulator in knee osteoarthritis: a randomized controlled clinical trial
Elsehrawy, G. G., Ibrahim, M. E., Moneim, N. H. A., Hefny, M., & El-Shaarawy, N. (2025) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-025-08288-6 · Cited by 23
Anhaltender postoperativer Schmerz bei Kindern und Jugendlichen
Williams, G., Howard, R. F., & Liossi, C. (2018) · Der Schmerz · doi:10.1007/s00482-018-0308-4 · Cited by 23
AAAPT Diagnostic Criteria for Acute Neuropathic Pain
Doshi, T. L., Dworkin, R. H., Polomano, R. C., Carr, D. B., Edwards, R. R., Finnerup, N. B., Freeman, R. L., Paice, J. A., Weisman, S. J., & Raja, S. N. (2020) · Pain Medicine · doi:10.1093/pm/pnaa407 · Cited by 23
Bedside testing for precision pain medicine
Reimer, M., Sachau, J., Forstenpointner, J., & Baron, R. (2021) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000556 · Cited by 21
“[18] 7 descriptors (0–5 categorical scale) one item radiating pain (yes/no) two spatiotemporal items (yes/no) 19/38: NeP likely 12–18: uncertain <12: unlikely Doleur Neuropathique 4 Questions (DN4) (interview, self-report) Bouhassira et al.”
BackgroundSelf-citation
Cross Cultural Adaptation and Validation of Italian Version of the Leeds Assessment of Neuropathic Symptoms and Signs Scale and Pain DETECT Questionnaire for the Distinction between Nociceptive and Neuropathic Pain
Migliore, A., Gigliucci, G., Moretti, A., Pietrella, A., Peresson, M., Atzeni, F., Sarzi‐Puttini, P., Bazzichi, L. M., Liguori, S., & Iolascon, G. (2021) · Pain Research and Management · doi:10.1155/2021/6623651 · Cited by 21
Neuropathic-like Pain in Fibrous Dysplasia/McCune-Albright Syndrome
Spencer, T., Watts, L. M., Soni, A., Pinedo‐Villanueva, R., Heegaard, A., Boyce, A. M., & Javaid, M. K. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac120 · Cited by 23
“Within each level of strongest pain during the past 4 weeks from 1 to 10, the proportion of individuals within in each pain with nociceptive, unclear, or neuropathic is shown as defined by the painDETECT questionnaire (33)”
BackgroundInfluential
Differences in Quantitative Sensory Testing Outcomes Between Patients With Low Back Pain in Primary Care and Pain-free Controls
den Bandt, H. L., Ickmans, K., Leemans, L., Nijs, J., & Voogt, L. P. (2022) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001038 · Cited by 21
Epigenetic age predictors in community-dwelling adults with high impact knee pain
Cruz‐Almeida, Y., Johnson, A. J., Meng, L., Sinha, P., Rani, A., Yoder, S., Huo, Z., Foster, T. C., & Fillingim, R. B. (2022) · Molecular Pain · doi:10.1177/17448069221118004 · Cited by 21
Coexistence of neuropathic corneal pain, corneal nerve abnormalities, depression, and low quality of life
Leonardi, A., Feuerman, O. M., Salami, E., Lazzarini, D., Cavarzeran, F., Freo, U., & Maggioni, F. (2023) · Eye · doi:10.1038/s41433-023-02710-w · Cited by 21
“The anonymous questionnaire combines different types of symptomatic pain assessment: VAS, FPS, a modified version of the S-LANSS, and the Pain Detect (PD) that focuses on neuropathic pain, in this case referred to the ocular district [28].”
Can the painDETECT Questionnaire score and MRI help predict treatment outcome in rheumatoid arthritis: protocol for the Frederiksberg hospital's Rheumatoid Arthritis, pain assessment and Medical Evaluation (FRAME-cohort) study
Rifbjerg-Madsen, S., Christensen, A. W., Boesen, M., Christensen, R., Danneskiold‐Samsøe, B., Bliddal, H., Bartels, E. M., Locht, H., & Amris, K. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-006058 · Cited by 21
“A score of 13–18 is considered ambiguous.(23)”
MethodInfluential
Female chronic pelvic pain is highly prevalent in Denmark. A cross-sectional population-based study with randomly selected participants
Loving, S., Thomsen, T., Jaszczak, P., & Nørdling, J. (2014) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2013.12.002 · Cited by 22
The clinical physiotherapy assessment of non-traumatic shoulder instability
Barrett, C. (2014) · Shoulder & Elbow · doi:10.1177/1758573214548934 · Cited by 21
Total Knee Arthroplasty due to Knee Osteoarthritis: Risk Factors for Persistent Postsurgical Pain
Gezer, İ. A., Apilioğulları, S., Erkoçak, Ö. F., Kavalci, H., Özerbil, Ö. M., & Levendoğlu, F. (2016) · Journal of the National Medical Association · doi:10.1016/j.jnma.2016.08.008 · Cited by 21
Clinimetric Testing of the Lumbar Spine Instability Questionnaire
Saragiotto, B. T., Maher, C. G., New, C. H., Catley, M. J., Hancock, M. J., Cook, C. E., & Hodges, P. W. (2018) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2018.7866 · Cited by 21
Avoiding Catch-22: validating the PainDETECT in a population of patients with chronic pain
Timmerman, H., Wolff, A. P., Bronkhorst, E. M., Wilder‐Smith, O. H. G., Schenkels, M. J., van Dasselaar, N. T., Huygen, F. J. P. M., Steegers, M. A. H., & Vissers, K. C. P. (2018) · BMC Neurology · doi:10.1186/s12883-018-1094-4 · Cited by 21
“5Bernhoven Ziekenhuis, Department of Anesthesiology, Uden, the Netherlands.”
BackgroundMethodInfluential
Efficacy and tolerability of orally administered tramadol/dexketoprofen fixed-dose combination compared to diclofenac/thiocolchicoside in acute low back pain: experience from an Italian, single-centre, observational study
Meloncelli, S., Divizia, M., & Germani, G. (2020) · Current Medical Research and Opinion · doi:10.1080/03007995.2020.1814228 · Cited by 21
Immediate Breast Reconstruction Does Not Increase Postmastectomy Pain
Henderson, J. R., Tao, A., Kirwan, C., & Barr, L. C. (2013) · Annals of Surgical Oncology · doi:10.1245/s10434-013-3293-y · Cited by 21
Design of the COMEBACK and BACKHOME Studies, Longitudinal Cohorts for Comprehensive Deep Phenotyping of Adults with Chronic Low-Back Pain (cLBP): a part of the BACPAC Research ProgramPreprint
Hue, T. F., Lotz, J. C., Zheng, P. Z., Black, D. M., Bailey, J. F., Ewing, S. K., Fields, A. J., Mehling, W. E., Scheffler, A., Strigo, I. A., et al. (2024) · medRxiv · doi:10.1101/2024.04.09.24305574 · Cited by 24
Neuropathic pain is not adequately treated in the older general population: Results from the KORA F4 survey
Meisinger, C., Bongaerts, B. W. C., Heier, M., Amann, U., Kowall, B., Herder, C., Rückert‐Eheberg, I., Rathmann, W., & Ziegler, D. (2018) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4559 · Cited by 20
“3 | Definition of neuropathic pain Neuropathic pain was assessed using the painDETECT questionnaire.(25) This validated 1‐page questionnaire is specifically directed to neuropathic pain symptoms and is easily to be completed during a clinic visit.”
Method
Neuropathic pain after sarcoma surgery
Park, J. W., Kim, H.-S., Yun, J. Y., & Han, I. (2018) · Medicine · doi:10.1097/md.0000000000010852 · Cited by 20
Prepulse inhibition of the blink reflex is abnormal in functional movement disorders
Hanzlíková, Z., Köfler, M., Slovák, M., Věchetová, G., Fečíková, A., Kemlink, D., Sieger, T., Růžička, E., Valls‐Solé, J., Edwards, M. J., et al. (2019) · Movement Disorders · doi:10.1002/mds.27706 · Cited by 23
“The average of these values (the current, the average and the maximal pain intensity = Pain composite score, total score 0 – 30) for each subject was used for analyses (Freynhagen, Baron, Gockel, & Tolle, 2006).”
Method
Multicentre, double-blind, randomised, sham-controlled trial of 10 khz high-frequency spinal cord stimulation for chronic neuropathic low back pain (MODULATE-LBP): a trial protocol
Al-Kaisy, A. A., Royds, J., Palmisani, S., Pang, D. C., Wesley, S., Taylor, R. S., Cook, A., Eldabe, S. S., McCracken, L. M., Duarte, R. V., et al. (2020) · Trials · doi:10.1186/s13063-019-3831-4 · Cited by 20

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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