DN4 questionnaire
Objective[edit | edit source]
A clinical screening tool used to diagnose the presence of neuropathic pain[1]. It was developed by the French Neuropathic Pain Group to address the difficulties and lack of consensus in diagnosing neuropathic pain[1] . The scale has been widely used since 2005 because of its simplicity.
Description[edit | edit source]
It is a clinician-administered questionnaire consisting of 10 items[2].
- Seven items related to pain quality (i.e. sensory and pain descriptors) are based on an interview with the patient. These components refer to how the pain feels to the patient
- Three items are based on the clinical examination. The clinician assesses whether there is reduced sensation (hyposthesia) to touch or pinprick and whether light brushing increases or causes pain (allodynia).
Languages[edit | edit source]
The DN4 questionnaire was originally developed and validated in French - It has since been translated and linguistically validated into English, Dutch, German, Greek, Hungarian and Farsi[3][4].
Intended Population[edit | edit source]
It can be used for any patient presenting with signs and symptoms that raise the suspicion of a neurological (peripheral or central) lesion. It can be used to identify cases where a neuropathic component is the main cause of pain or to identify it as a contributor to pain in more complex conditions.
Conditions that often have a neuropathic pain component[1]:
- Complex Regional Pain Syndrome (CRPS) type 1
- Lumbar or Cervical Radiculopathy
- Brachial Plexus injuries
- Peripheral neuropathies
- Central Nervous System lesions (eg. Stroke, Traumatic brain injury, Multiple Sclerosis)
- Polyneuropathies
- Trigeminal Neuralgia
Methods of Use[edit | edit source]
The 7 symptoms items are scored by interviewing the patient, and the 3 remaining items are scored by means of clinical examination. The scores are added and a score of 4 or more out of 10 is suggestive of neuropathic pain[2].
Evidence[edit | edit source]
This questionnaire has been well validated in a number of studies. In a recent Systematic Review, the DN-4 was identified as one of the most suitable neuropathic pain screening tools for clinical use[5].
- Sensitivity: Ranges from 75-98%[6]. Proven high sensitivity for central neuropathic pain and polyneuropathies. Sensitivity is low for tigeminal neuralgia[7]. Moderate sensitivity for detecting a neuropathic component of pain in people with chronic pain[8].
- Specificity: Ranges from 37-96% [6].
- It is a reliable component of the diagnostic work up for painful diabetic polyneuropathy: Inter-rater agreement coefficient:0.80 (0.71–0.89), and test-retest intra-class correlation coefficient: 0.95 (0.92–0.97)].[9]
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). pain. 2005 Mar 1;114(1-2):29-36.
- ↑ 2.0 2.1 Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, Scholz J, Tölle TR, Wittchen HU, Jensen TS. Using screening tools to identify neuropathic pain. Pain. 2007 Feb 1;127(3):199-203.
- ↑ Van Seventer R, Vos C, Meerding W, Mear I, Le Gal M, Bouhassira D, Huygen FJ. Linguistic validation of the DN4 for use in international studies. European journal of pain. 2010 Jan 1;14(1):58-63.
- ↑ Madani, S.P., Fateh, H.R., Forogh, B., Fereshtehnejad, S.M., Ahadi, T., Ghaboussi, P., Bouhassira, D. and Raissi, G.R., 2014. Validity and reliability of the persian (farsi) version of the DN 4 (douleur neuropathique 4 questions) questionnaire for differential diagnosis of neuropathic from non‐neuropathic pains. Pain Practice, 14(5), pp.427-436.
- ↑ Mathieson S, Maher CG, Terwee CB, De Campos TF, Lin CW. Neuropathic pain screening questionnaires have limited measurement properties. A systematic review. Journal of clinical epidemiology. 2015 Aug 1;68(8):957-66.
- ↑ 6.0 6.1 Fagbohun TR. Systematic Review on the Psychometric, Reliability and Validity Properties of Translated Neuropathic Pain Screening Tools (DN4, LANSS and PDQ). International Journal of Medicine and Medical Research. 2021;7(1):51-67.
- ↑ VanDenKerkhof EG, Stitt L, Clark AJ, Gordon A, Lynch M, Morley-Forster PK, Nathan HJ, Smyth C, Toth C, Ware MA, Moulin DE. Sensitivity of the DN4 in screening for neuropathic pain syndromes. The Clinical Journal of Pain. 2018 Jan 1;34(1):30-6.
- ↑ Timmerman H, Steegers MA, Huygen FJ, Goeman JJ, Van Dasselaar NT, Schenkels MJ, Wilder-Smith OH, Wolff AP, Vissers KC. Investigating the validity of the DN4 in a consecutive population of patients with chronic pain. PLoS One. 2017 Nov 30;12(11):e0187961.
- ↑ Spallone V, Morganti R, D’Amato C, Greco C, Cacciotti L, Marfia GA. Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy. Diabetic Medicine. 2012 May;29(5):578-85.
