Neuropathic pain screening tools

Accurate and reliable differentiation between neuropathic pain and nociceptive pain is required in the clinical setting to select an appropriate therapeutic approach, and in the research setting for case ascertainment. However, the diagnosis of neuropathic pain can be difficult, especially for the non-specialist, and in this regard numerous screening tools have been developed to assist in the identification of whether a patient's pain is likely to be neuropathic in origin1. Key tools include the: Leeds assessment of neuropathic symptoms and signs (LANSS)2,3, neuropathic pain questionnaire (NPQ)4, douleur neuropathique en 4 questions (DN4)5, painDETECT6, and ID-Pain7.

All neuropathic pain screening tools rely on assessment of verbal pain descriptors that are typical in neuropathic pain states, with some tools also involving a brief examination of sensory signs. The reliance of these tools on the assessment of verbal pain descriptors complicates the use of these instruments outside of the populations they were developed unless there is proper linguistic and cultural translation of the instrument, followed by assessment of the instruments reliability and validity in the new population. In this regard, there has been a significant increase in the number of methodologically sound translations and validations of some screening tools, which has broadened the availability of screening tools for neuropathic pain outside of the populations they were originally developed in.

To increase awareness of the translations and validations of neuropathic pain screening tools that are available, NeuPSIG has developed a database listing the languages in which various screening tools are available, and describing the reliability and validity of the translations where that information is available. We only list translations that have gone through recognized translation procedures (i.e., forward and reverse translation with consensus discussion on semantic meaning and cultural equivalence). Currently the database includes information on two screening tools (LANSS and DN4), but information on more tools will be added in due course.

We encourage users to inform us of any additions or corrections to the database (Email: Peter Kamerman at NeuPSIG.tools@gmail.com).

Questionnaire
  Leeds assessment of neuropathic
symptoms and signs
(LANSS)
Douleur neuropathique en 4 questions
(DN4)
Original language English2 French5
Assessment Signs and symptoms Signs and symptoms
Validated uses Neuropathic vs. nociceptive2 Neuropathic vs. nociceptive5
  Self-administered version (S-LANSS)3 Neuropathic pain following spinal cord injury10
  Neuropathic pain in head and head cancer8 Painful diabetic polyneuropathy11
  Neuropathic component of chronic low back pain9  
  Neuropathic pain following spinal cord injury10  
Translated
(unless otherwise indicated,
translations are available through
the MAPI Institute+ or ProQolid++)
Norwegian Danish, Dutch,English 5, German, Greek,
Hungarian, Russian, Thai12
Translated and validated Portuguese (Brazilian)13, Spanish14, Swedish10,
Turkish15, Turkish (S-LANSS)16
Arabic (Moroccan)†17, Italian11, Portuguese
(Brazilian)
18, Spanish19, Swedish10, Turkish20

+ MAPI-institute (www.mapi-institute.org). Fees may apply; see website for details

++ ProQolid (www.proqolid.org). Fees may apply; see website for details

† Only the seven-item symptom assessment component translated and validated (DN4 interview)

References

  1. Bennett, M. I. et al. Using screening tools to identify neuropathic pain. Pain 127, 199-203 (2007).
  2. Bennett, M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92, 147-157 (2001).
  3. Bennett, M. I., Smith, B. H., Torrance, N. & Potter, J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain 6, 149-158 (2005).
  4. Krause, S. J. & Backonja, M.-M. Development of a neuropathic pain questionnaire. Clin J Pain 19, 306-314 (2003).
  5. Bouhassira, D. et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114, 29-36 (2005).
  6. Freynhagen, R., Baron, R., Gockel, U. & Tölle, T. R. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 22, 1911-1920 (2006).
  7. Portenoy, R. Development and testing of a neuropathic pain screening questionnaire: ID Pain. Curr Med Res Opin 22, 1555-1565 (2006).
  8. Potter, J., Higginson, I. J., Scadding, J. W. & Quigley, C. Identifying neuropathic pain in patients with head and neck cancer: use of the Leeds Assessment of Neuropathic Symptoms and Signs Scale. J Royal Soc Med 96, 379-383 (2003).
  9. Kaki, A. M., El-Yaski, A. Z. & Youseif, E. Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Reg Anesth Pain Med 30, 422-428 (2005).
  10. Hallström, H. & Norrbrink, C. Screening tools for neuropathic pain: can they be of use in individuals with spinal cord injury? Pain 152, 772-779 (2011).
  11. Spallone, V. et al. Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy. Diabet Med 29, 578-585 (2012).
  12. Chaudakshetrin, P. et al. Cross-cultural adaptation to the Thai language of the neuropathic pain diagnostic questionnaire (DN4). J Med Assoc Thai 90, 1860-1865 (2007).
  13. Schestatsky, P. et al. Brazilian Portuguese Validation of the Leeds Assessment of Neuropathic Symptoms and Signs for Patients with Chronic Pain. Pain Med (2011).doi:10.1111/j.1526-4637.2011.01221.x
  14. Pérez, C. et al. Linguistic adaptation and Spanish validation of the LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) scale for the diagnosis of neuropathic pain. Med Clin (Barc) 127, 485-491 (2006).
  15. Yucel, A., Senocak, M., Kocasoy Orhan, E., Cimen, A. & Ertas, M. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study. J Pain 5, 427-432 (2004).
  16. Koc, R. & Erdemoglu, A. K. Validity and reliability of the Turkish Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire. Pain Med 11, 1107-1114 (2010).
  17. Harifi, G. et al. Validity and reliability of the Arabic adapted version of the DN4 questionnaire (Douleur Neuropathique 4 Questions) for differential diagnosis of pain syndromes with a neuropathic or somatic component. Pain Prac 11, 139-147 (2011).
  18. Santos, J. G. et al. Translation to Portuguese and validation of the Douleur Neuropathique 4 questionnaire. J Pain 11, 484-490 (2010).
  19. Perez, C. et al. Validity and reliability of the Spanish version of the DN4 (Douleur Neuropathique 4 questions) questionnaire for differential diagnosis of pain syndromes associated to a neuropathic or somatic component. Health Qual Life Outcomes 5, 66 (2007).
  20. Unal-Cevik, I., Sarioglu-Ay, S. & Evcik, D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. J Pain 11, 1129-1135 (2010).