Distinguishing neuropathic pain from nocioceptive pain

This study quantifies the value of the history among 269 patients with chronic pain in three pain clinics.

Summary:

  • Neither their survey nor any individual findings were strong enough to hang one’s hat on.
  • The most helpful finding when present was a sensation of brushing.
  • The most helpful finding when absent was numbness.

 Methods:

  • Patients: 196 patients in whom two physicians agreed on the basis of the pain. Excluded were 106 patients for whom the physicians agreed that the pain had a mixed basis or for whom the physicians did not agree whether the pain was neuropathic.
  • Gold standard: consensus assessment by two physicians of the basis of the pain.

Findings:

Accuracy

Predictive value
(assuming equal pretest probabilities of neuropathic and nocioceptive pain)

Finding Sensitivity Specificity Positive predictive value Negative predictive value
DN4 7-item survey(score 4 or more)

74

79

78

75

Numbness sensation

74

68

70

73

Painful cold sensation

64

80

76

69

Brushing sensation

51

91

85

65

Citation

van Seventer R, Vos C, Giezeman M, Meerding WJ, Arnould B, Regnault A, van Eerd M, Martin C, & Huygen F (2013). Validation of the Dutch version of the DN4 diagnostic questionnaire for neuropathic pain. Pain practice : the official journal of World Institute of Pain, 13 (5), 390-8 PMID: 23113981

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