Sensitivity of the DN4 in Screening for Neuropathic Pain Syndromes

Abstract

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.

Development of an Evidence-Based Practical Diagnostic Checklist and Corresponding Clinical Exam for Low Back Pain

“…The DN4 has been independently assessed and consistently reported to be among the most discriminative instruments available. [60][61][62][63] Some practitioners may wish to perform examination tests for a specific diagnosis before moving to another category. In such cases, the checklist can provide examination guidance.…”

Association between Neuropathic Pain Characteristics and DNA Methylation of <em>TRPA1</em> in Human Peripheral Blood

“…We used the DN4 questionnaire to discriminate neuropathic pain from other pain states [7,8]. The DN4 questionnaire evaluates 10 items: characteristics of pain (burning (1), painful cold (2), electric shocks (3)), symptoms in the region of pain (tingling (4), pins and needles (5), numbness (6), itching (7)), localized pain (hypoesthesia to touch (8), hypoesthesia to pricking (9)) and pain caused or increased by brushing in the painful area (10). Items #1 to #7 of the DN4 questionnaire are answered by interviewing patients, and items #8 to #10 require examination of patients.…”

“…The Douleur Neuropathique 4 (DN4) questionnaire, which includes ten pain characteristics, was developed to screen for neuropathic pain [7,8]. These neuropathic pain characteristics reportedly correlate with pain intensity, depression and anxiety in patients with chronic pain [9,10] and cancer pain [11,12].…”

“…, further investigations are needed to evaluate the association between pressure pain threshold and DNA methylation at CpG -51 in patients under treatment for neuropathic pain.Increases in the methylation rates of TRPA1 tended to be associated with pain intensity or depression, but not with anxiety, in the present study. Although neuropathic pain characteristics correlate with pain intensity and depression[9][10][11][12], there might be no clear relationship between TRPA1 methylation rates, pain intensity and depression.Therefore, DNA methylation of the TRPA1 is unlikely a confounder for pain intensity or depression in neuropathic pain states.A limitation of this study is that the origin of the TRPA1 gene in whole blood is unclear.TRPA1expression as a nociceptor at primary sensory neurons plays pivotal roles in the development and maintenance of neuropathic pain [24, 25]. On the other hand, TRPA1 expressed in immune cells also contributes to chronic pain [26].…”

Long-Term Outcomes in the Management of Central Neuropathic Pain Syndromes: A Prospective Observational Cohort Study

“…The diagnosis of neuropathic pain was based on clinical criteria and supported by validated questionnaires (Douleur Neuropathique en 4 [DN4]). 10,11 Initial patient assessment and subsequent follow-ups were conducted in-person at each Pain Center. Study follow-up was arranged for 3, 6, and 12 months in all patients to assess the efficacy of treatment.…”