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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‡‡

doi: 10.1097/AJP.0000000000000512
Original Articles

Objectives: 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.

Materials and Methods: 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 on the basis of history, neurological examination, and ancillary diagnostic tests.

Results: The mean age of study participants was 53.5 years and 54.7% were female; 83% (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 (odds ratio [OR]=4.35; 95% confidence interval [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 with focal neuropathies.

Discussion: 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 because of 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.

*Department of Anesthesiology & Perioperative Medicine, School of Nursing, Queens University, Kingston

LW Stitt Statistical Services

Department of Anesthesia & Perioperative Medicine

‡‡Department of Clinical Neurological Sciences, Western University, London

§Wasser Pain Management Centre, Mount Sinai Hospital, University of Toronto, Toronto

#Department of Anesthesiology, University of Ottawa, Ottawa, ON

Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax

Anesthesiology, Pain Medicine and Perioperative Care, Psychiatry Pharmacology, Dalhousie University, Halifax, NS

**Burnaby Hospital, Burnaby, BC

††Department of Family Medicine, McGill University, Montreal, QC, Canada

Supported by the Canadian Foundation for Innovation (grant number 7878) and by Pfizer, Canada.

The authors declare no conflict of interest.

Reprints: Elizabeth G. VanDenKerkhof, RN, DrPH, School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON, Canada K7L 3N6 (e-mail:

Received September 13, 2016

Received in revised form March 17, 2017

Accepted April 23, 2017

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