Call for Caution in Using the Pain DETECT Questionnaire for Patient Stratification Without Additional Clinical Assessments: Comment on the Article by Soni et al

Hasvik, Eivind; Haugen, Anne Julsrud; Grøvle, Lars

doi:10.1002/art.40804

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…Nevertheless, the cold pressor test is the most common method used [ 35 ] and has good to excellent intra-session reliability in healthy and people with chronic pain [ 49 ] for conditioned pain modulation assessment. Also, the painDETECT questionnaire can identify neuropathic-like symptoms, but positive neuropathic classification in the painDETECT is insufficient to classify neuropathy [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Does the painDETECT questionnaire identify impaired conditioned pain modulation in people with musculoskeletal pain? – a diagnostic accuracy study

Bittencourt,

Leivas,

de Sá Ferreira

et al. 2023

Arch Physiother

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Background People with neuropathic-like symptoms had more unfavourable pain features than people with nociceptive. Moreover, deficient conditioned pain modulation is common in people with neuropathic-like symptoms. PainDETECT questionnaire have been used to assess the central sensitisation sign and symptoms. However, whether the painDETECT questionnaire can identify the conditioned pain modulation's impairment is still unknown. Therefore, the current study aimed to evaluate the diagnostic accuracy of the painDETECT questionnaire in detecting the impairment of conditioned pain modulation in people with musculoskeletal pain. Methods We conducted a diagnostic accuracy comparing the painDETECT questionnaire (index method) with the cold pressor test, the psychophysical test used to assess the conditioned pain modulation (reference standard). We determined diagnostic accuracy by calculating sensitivity, specificity, predictive values, and likely hood ratios. Results We retrospectively enrolled 308 people with musculoskeletal pain in outpatient departments. Most participants were female (n 20 = 220, 71.4%) and had a mean age of 52.2 (± 15.0) years. One hundred seventy-three (56.1%) participants were classified as nociceptive pain, 69 (22.4%) as unclear, and 66 (21.4%) as neuropathic-like symptoms. According to the cold pressor test, 60 (19.4%) participants presented impairment of conditioned pain modulation. The cutoff point of 12 of the painDETECT questionnaire showed values of diagnostic accuracy below 70% compared to the cold pressor test, except for a negative predictive value [76.9 95% Confidence Interval (CI) 71.7 to 81.5]. The cutoff point 19 showed high specificity (78.6%, 95% CI 73.0 to 83.5), high negative predictive value (80.5%, 95% CI 78.1 to 82.7), and accuracy of 67.5% compared to the cold pressor test. Conclusion The painDETECT questionnaire seems valuable for ruling out people with musculoskeletal pain and impairment of conditioned pain modulation.

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Section: Discussionmentioning

confidence: 99%

Does the painDETECT questionnaire identify impaired conditioned pain modulation in people with musculoskeletal pain? – a diagnostic accuracy study

Bittencourt,

Leivas,

de Sá Ferreira

et al. 2023

Arch Physiother

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“…Regarding the limitations of the painDETECT questionnaire, the main one is that the classification probable neuropathic may be insufficient to classify neuropathy. 14 However, the painDETECT questionnaire can identify neuropathic-like symptoms, 14 and when compared to Douleur Neuropathique en 4 Questions and the Leeds Assessment of Neuropathic Symptoms and Signs, the painDETECT questionnaire had higher values of sensitivity and specificity. 5 Besides, we did not control the diagnoses, medications, or interventions that participants recruited for the pretesting phase were receiving, which may interfere in pain perception.…”

Section: Discussionmentioning

confidence: 99%

Cross-cultural adaptation of the painDETECT questionnaire into Brazilian Portuguese

Rio

Bittencourt

Corrêa

et al. 2022

Brazilian Journal of Anesthesiology (English Edition)

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“…4,5,31-33 However, we can also suppose that the severity and the chronicity of OA nociceptive pain, frequently associated with mood disorders, could induce a misinterpretation of symptoms by patients, and so explain a part of porosity between nociceptive and neuropathic symptoms especially in the absence of objective assessment of neurogenic impairment. 34-36 In our study, the presence of NP was evaluated using the DN4 questionnaire, which has been previously validated as an efficient tool to assess NP. 15 However, there is no gold standard for this purpose.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, while there are studies supporting its use for stratifying patients into those with NP and those with nociceptive pain, 14 there are concerns about its validity, especially the modified version used for knee OA. 34 Moreover, self-reported questionnaires may not be reliable and must always be correlated to clinical examination of the patient. 34,39,40 The same applies to another tool used for screening for NP, the Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire, which is also a patient-reported measure and, though it has been validated, 5 might raise the same concerns [34].…”

Section: Discussionmentioning

confidence: 99%

“…34 Moreover, self-reported questionnaires may not be reliable and must always be correlated to clinical examination of the patient. 34,39,40 The same applies to another tool used for screening for NP, the Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire, which is also a patient-reported measure and, though it has been validated, 5 might raise the same concerns [34]. To our knowledge, there are no studies in the literature that have specifically searched for issues raised by the DN4 or proven any invalid or incorrect results obtained with this questionnaire.…”

Section: Discussionmentioning

confidence: 99%

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Does the Presence of Neuropathic Pain Influence the Response to Hyaluronic Acid in Patients with Knee Osteoarthritis?

Tiendrebeogo¹,

Choueiri²,

Chevalier³

et al. 2020

CARTILAGE

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Objectives Up to 50% of patients with symptomatic knee osteoarthritis (OA) present with neuropathic pain (NP) features. We assessed the impact of NP according to DN4 (Douleurs Neuropathiques 4 questions) score on the response to intra-articular (IA) hyaluronic acid (HA) injections and the effects of HA injections on NP. Materials and Methods We conducted a post hoc analysis from a multicenter, randomized, double-blind, noninferiority trial comparing the efficacy of 2 HA in symptomatic knee OA at 24 weeks. At baseline, demographic, anthropometric, radiologic data, and symptoms were recorded. The symptomatic effect of HA was assessed by VAS pain, patient global assessment (PGA), WOMAC, DN4, and OMERACT-OARSI response. Results A total of 187 patients were included. NP according to DN4 score was present in 20 patients (10.7%) at baseline. Most common positive DN4 items were tingling (36.9%) and burning (36.4%). NP was associated with WOMAC pain score ( P = 0.02). The presence of NP at baseline did not affect the symptomatic improvement after HA injections according to the VAS pain ( P = 0.71), PGA ( P = 050), WOMAC pain ( P = 0.89), WOMAC function ( P = 0.52), and rate of OMERACT-OARSI responders ( P = 0.21). The prevalence of patients with NP decreased by 50% ( n = 10) at 24 weeks after HA injections. Most improved DN4 items were itching (90%), hypoesthesia to pinprick (88%), and burning (50%). Conclusion In our study, NP was associated with pain severity, but did not influence the response to IA HA. On the other hand, HA injections reduced some NP features, especially itching, sting hypoesthesia, and burning.

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Call for Caution in Using the Pain DETECT Questionnaire for Patient Stratification Without Additional Clinical Assessments: Comment on the Article by Soni et al

Cited by 4 publications

References 14 publications

Does the painDETECT questionnaire identify impaired conditioned pain modulation in people with musculoskeletal pain? – a diagnostic accuracy study

Does the painDETECT questionnaire identify impaired conditioned pain modulation in people with musculoskeletal pain? – a diagnostic accuracy study

Cross-cultural adaptation of the painDETECT questionnaire into Brazilian Portuguese

Does the Presence of Neuropathic Pain Influence the Response to Hyaluronic Acid in Patients with Knee Osteoarthritis?

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