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Sensitivity of the DN4 in Screening for Neuropathic Pain Syndromes

VanDenKerkhof, Elizabeth G. RN, DrPH; Stitt, Larry MSc; Clark, Alexander J. MD, FRCPC; Gordon, Allan MD; Lynch, Mary MD, FRCPC; Morley-Forster, Patricia K. MD; Nathan, Howard J. MD; Smyth, Catherine MD, PhD, FRCPC; Toth, Cory MD, FRCPC; Ware, Mark A. MD; Moulin, Dwight E. MD
The Clinical Journal of Pain: Post Acceptance: May 05, 2017
doi: 10.1097/AJP.0000000000000512
Original Article: PDF Only


Several tools have been developed to screen for neuropathic pain. This study examined the sensitivity of the Douleur Neuropathique en 4 Questions (DN4) in screening for various neuropathic pain syndromes.


This prospective observational study was conducted in 7 Canadian academic pain centers between April 2008 and December 2011. All newly admitted patients (n=2199) were approached and 789 eligible participants form the sample for this analysis. Baseline data included demographics, disability, health-related quality of life and pain characteristics. Diagnosis of probable or definite neuropathic pain was based on history, neurological examination and ancillary diagnostic tests.


The mean age of study participants was 53.5 years and 54.7% were female. Eighty-three percent (n=652/789) screened positive on the DN4 (≥4/10). The sensitivity was highest for central neuropathic pain (92.5%, n=74/80) and generalized polyneuropathies (92.1%, n=139/151), and lowest for trigeminal neuralgia (69.2%, n=36/52). After controlling for confounders, the sensitivity of the DN4 remained significantly higher for individuals with generalized polyneuropathies (OR=4.35, 95% CI 2.15, 8.81), central neuropathic pain (OR=3.76, 95% CI 1.56, 9.07), and multifocal polyneuropathies (OR=1.72, 95% CI 1.03, 2.85) compared to focal neuropathies.


The DN4 performed well; however, sensitivity varied by syndrome and the lowest sensitivity was found for trigeminal neuralgia. A positive DN4 was associated with greater pain catastrophizing, disability and anxiety/depression, which may be due to disease severity, and/or these scales may reflect magnification of sensory symptoms and findings. Future research should examine how the DN4 could be refined to improve its sensitivity for specific neuropathic pain conditions.

The authors declare no conflict of interest.

Reprints: Elizabeth G. VanDenKerkhof, RN, DrPH, Professor and Sally Smith Chair, School of Nursing, Queen’s University, 92 Barrie St., Kingston, Ontario, Canada, K7L 3N6 (e-mail:;

Received September 13, 2016

Accepted April 23, 2017

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