Usefulness of painDETECT and S-LANSS in identifying the neuropathic component of mixed pain among patients with tumor-related cancer pain

Prevalence of neuropathic pain in terminally ill patients with cancer admitted to a general ward: a prospective observational study

“…However, it is unclear whether the observed higher pain intensity in NP patients could have been mitigated simply by increasing the dose of narcotics because NP is resistant to the effects of these drugs. 16 Nevertheless, our results suggest the importance of NP diagnosis in cancer patients because NP leads to more intense pain, and effective treatment often requires multimodal therapies, including coanalgesics and radiation. Some of these therapies may be beyond the expertise of non-specialists in cancer pain control.…”

“…The accurate diagnosis of NP in patients with cancer can be difficult: it is characteristically different from typical NP without cancer because of the coexistence of nociceptive pain. 16,17 Moreover, there are no guidelines for the use of coanalgesics in treating NP in cancer patients. For these reasons, it is necessary for pain management specialists to quantify the NP component involved in each patient's pain, and to evaluate the indications of coanalgesics in patients with cancer.…”

“…14 Although other screening tools for NP have been applied in non-cancer patients, past studies have reported that their diagnostic accuracy is insufficient in patients with cancer because—as we also demonstrated—such patients rarely have pure NP and often show characteristics of mixed pain, with both neuropathic and nociceptive components. 16,17 The nociceptive component of mixed pain in cancer patients may complicate the identification of the neuropathic component when screening tools such as painDETECT 18 and S-LANSS 16,19 are used. Thus, a thorough clinical assessment by pain specialists is fundamental for the diagnosis of NP in patients with cancer.…”

Accuracy of neuropathic pain measurements in patients with symptoms of polyneuropathy: validation of painDETECT, Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs, and Douleur Neuropathique 4

“…Aside from this, many studies report on the diagnostic accuracy of the 3 tools in other patient populations and across several languages but with widely different results. For example, Youden index for S-LANSS ranges from 0.06 in a study on cancer patients 28 to a near perfect 0.95 in patients with mixed etiology. 63 Likewise, studies on painDETECT and DN4 report Youden indices from below 0.2 16,44 to 0.71 22 and 0.92, 25 respectively.…”

“…The diagnostic accuracy of neuropathic pain tools depend on the patient population in question. 2,20,24,26,28,53 Most of the knowledge about the diagnostic accuracy of painDETECT, S-LANSS, and DN4 in patients with polyneuropathy is derived from studies of patients in pain clinics with mixed etiology, including, eg, arthritis, phantom pain, complex regional pain syndrome, or back pain. 5,14,32,41,49 This is problematic because different patient groups display diverse clinical presentations and degrees of co-morbidity that may affect the score of the clinical tools.…”