Psychometric and accuracy comparison of three commonly used questionnaires for the diagnosis of neuropathic pain

Abstract

Objectives: Diagnosis of neuropathic pain is challenging. Recently, scientists developed multiple questionnaires to expedite this diagnosis including the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), Douleur Neuropathique 4 questionnaire (DN4), and Neuropathic Pain Questionnaire–Short Form (NPQ-SF). Materials and Methods: We conducted a prospective cohort study to compare the psychometric characteristics and accuracy of the three questionnaires. We assessed reliability with the Cronbach's α reliability coefficient and inter-item correlations, and validity with receiver operating characteristic (ROC) and correlation analyses. We assessed agreement between the diagnosis of the questionnaires and the reference clinical diagnosis using Cohen's kappa coefficient. Results: 188 patients were analyzed: 141 (75%) had “definite neuropathic” and 47 (25%) had “nonneuropathic” pain. The NPQ-SF and S-LANSS questionnaires demonstrated acceptable reliability with Cronbach's α coefficient values of 0.54 (95% CI: 0.41–0.64) and 0.65, (95%CI: 0.57–0.72), respectively. The DN4 questionnaire demonstrated high reliability with Cronbach's α coefficient of 0.74 (95%CI: 0.68–0.79). The NPQ-SF, DN4, and S-LANSS questionnaires demonstrated “excellent” diagnostic ability with an area under the ROC curve of 0.82 (95% CI: 0.75–0.89), 0.89 (95% CI: 0.83–0.95), and 0.83 (95% CI: 0.75–0.90), respectively. Based on their optimal cutoff values, the DN4 had the highest sensitivity and lowest specificity in discriminating between neuropathic and nonneuropathic patients, while the S-LANSS had the lowest sensitivity and highest specificity. Conclusion: Both NPQ-SF and S-LANSS demonstrated acceptable reliability, while DN4 demonstrated high reliability. All three demonstrated excellent diagnostic validities; however, it is important to consider the sensitivity and specificity of each.

Perceived stress and pain interference in acute rehabilitation following spinal cord injury: Resilience as a moderator.

“…In the current study, the DN4 demonstrated acceptable reliability via Kuder-Richardson Formula 20 (KR-20 = .723) and in a range similar to that found by others (Abolkhair et al, 2021).…”

“…Affirmative responses are summed for a total score (Bouhassira et al, 2005, 2008). The DN4 has demonstrated higher reliability relative to other general NP measures (Abolkhair et al, 2021) and is reliable and valid in the assessment of SCI-related pain (Hallström & Norrbrink, 2011). In the current study, the DN4 demonstrated acceptable reliability via Kuder–Richardson Formula 20 (KR-20 = .723) and in a range similar to that found by others (Abolkhair et al, 2021).…”

“…Affirmative responses are summed for a total score (Bouhassira et al, 2005(Bouhassira et al, , 2008. The DN4 has demonstrated higher reliability relative to other general NP measures (Abolkhair et al, 2021) and is reliable and valid in the assessment of SCI-related pain (Hallström & Norrbrink, 2011).…”

Comparison of three measures for insomnia in ischemic stroke patients: Pittsburgh sleep quality index, insomnia severity index, and Athens insomnia scale

“…The value of AUC ranges from 0.5 to 1. The diagnostic value is acceptable when the score is between 0.71 and 0.8, excellent when it is 0.81–0.9, and outstanding when it is >0.9 ( 46 ). DeLong’s test ( 47 ) was performed to compare multiple ROC curves.…”

Usefulness of the DN4, S-LANSS, and painDETECT screening questionnaires to detect the neuropathic pain components in people with acute whiplash-associated disorders: a cross-sectional study

“…Previous studies also found that the S-LANSS showed higher specificity than did the DN4 24 , 28 or PDQ 28 in low back pain 28 and polyneuropathy. 24 Furthermore, S-LANSS previously showed similar discriminant validity for NP 55 and demonstrated superiority to other tools (eg, DN4, 55 PDQ 24 ). These findings could be explained by the items for self-assessment of allodynia and hyperalgesia included in the S-LANSS targeting the affected area and potentially enabling more accurate identification of the pathophysiology related to pain.…”