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

Abstract

Objective Although the presence of neuropathic pain (NP) components has been reported in whiplash-associated disorders (WAD), no studies have analyzed the usefulness of NP screening questionnaires to detect NP components in WAD. This study aimed to assess the usefulness of three screening NP tools (Douleur Neuropathique 4 [DN4], self-administered Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS], and painDETECT questionnaire [PDQ]) to detect the presence of NP components in acute WAD. Design A cross-sectional study. Setting Hospital. Subjects Of 188 eligible individuals, fifty people (68% women, mean age = 40.3 ± 12.5 years) with acute WAD (52% Grade III) were included. Methods Specialized physicians initially screened participants for the presence of NP components according to clinical practice and international recommendations. After physician assessment, blinded investigators assessed participants using NP screening questionnaires (DN4, S-LANSS, PDQ) within 2 weeks of accident. Diagnostic accuracy of these tools was analyzed and compared to the reference standard (physicians’ assessments). Results : The three screening questionnaires showed excellent discriminant validity (area under the curve [AUC] ≥ 0.8), especially S-LANSS (AUC : 0.9; p < 0.001). DN4 demonstrated the highest sensitivity (87%) followed by S-LANSS (75%), while S-LANSS and PDQ showed the highest specificity (85% and 82%, respectively). These tools demonstrated a strong correlation with the reference standard (S-LANSS: Rho = 0.7; PDQ: Rho = 0.62; DN4: Rho = 0.7; all, p < 0.001). Conclusions The DN4, S-LANSS and PDQ show excellent discriminant validity to detect the presence of NP components in acute WAD, especially S-LANSS. Initial screening with these tools might improve management of WAD.