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Can self-reported pain characteristics and bedside test be used for the assessment of pain mechanisms? An analysis of results of neuropathic pain questionnaires and quantitative sensory testing

Gierthmühlen, Jannea,*; Schneider, Ulrikea; Seemann, Martinaa; Freitag-Wolf, Sandrab; Maihöfner, Christianc; Enax-Krumova, Elena K.d,e; Azad, Shahnaz-C.f; Üçeyler, Nurcang; Birklein, Frankh; Maier, Christophd; Tölle, Thomasi; Treede, Rolf-Detlefj; Baron, Ralfa

doi: 10.1097/j.pain.0000000000001601
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Hyperalgesia and allodynia are frequent in neuropathic pain. Some pain questionnaires such as the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and the Neuropathic Pain Scale (NPS) include self-assessment or bedside testing of hyperalgesia/allodynia. The aim of this study was to determine to what extent LANSS and NPS data are congruent with findings on quantitative sensory testing (QST). Self-reported presence of dynamic mechanical allodynia (DMA) and descriptors of hot, cold, or deep ongoing pain (the NPS and LANSS) as well as bedside findings of mechanical allodynia (LANSS) were compared with signs of DMA and thermal hyperalgesia on QST in 617 patients with neuropathic pain. Self-reported abnormal skin sensitivity (LANSS) showed a moderate concordance with DMA during bedside test (67.9%, κ = 0.391) or QST (52.8%, κ = 0.165). Receiver operating curve analysis for self-reported DMA yielded similar area-under-the-curve values for the LANSS (0.65, confidence interval: 0.59%-0.97%) and NPS (0.71, confidence interval: 0.66%-0.75%) with high sensitivity but low specificity. Self-reported deep pain intensity was higher in patients with blunt pressure hyperalgesia, but not in patients with DMA or thermal hyperalgesia. No correlations were observed between self-reported hot or cold pain quality and thermal hyperalgesia on QST. Self-reported abnormal skin sensitivity has a high sensitivity to identify patients with DMA, but its low specificity indicates that many patients mean something other than DMA when reporting this symptom. Self-reported deep pain is related to deep-tissue hypersensitivity, but thermal qualities of ongoing pain are not related to thermal hyperalgesia. Questionnaires mostly evaluate the ongoing pain experience, whereas QST mirrors sensory functions. Therefore, both methods are complementary for pain assessment.

Self-reported symptoms show only little or moderate association with findings on quantitative sensory testing. Both methods should be used complementary for pain assessment and optimizing treatment.

aDivision of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany

bInstitut of Medical Informatics and Statistics, University of Kiel, University Hospital of Schleswig-Holstein, Campus Kiel, Germany

cDepartment of Neurology, General Hospital Fürth, Fürth, Germany

Departments of dPain Management and

eNeurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany

fDepartment of Anesthesiology, University Hospital Munich, Campus Groβhadern, Munich, Germany

gDepartment of Neurology, University of Würzburg, Würzburg, Germany

hDepartment of Neurology, University Medical Centre Mainz, Mainz, Germany

iDepartment of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

jChair of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany

*Corresponding author. Address: Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, Haus 41, 24105 Kiel, Germany. Tel.: +49 431 500 23911. E-mail address: j.gierthmuehlen@neurologie.uni-kiel.de (J. Gierthmühlen).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

© 2019 International Association for the Study of Pain
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