Douleur Neuropathique in 4 Questions (DN4) proved more sensitive to neuropathic pain in cancer than the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) – 87.5% for DN4 versus 68.1% for LANSS in sensitivity. However LANSS had slightly better specificity – 93.4% for LANSS versus 88.4% for DN4 – not that much difference though. I have always like the LANSS but this suggest the DN4 might be a better tool.
Eur J Pain. 2015 Jul;19(6):752-61. doi: 10.1002/ejp.598.
Prevalence of pain and relative diagnostic performance of screening tools for
neuropathic pain in cancer patients: A cross-sectional study.
Pérez C(1), Sánchez-Martínez N, Ballesteros A, Blanco T, Collazo A, González F,
Villoria J
http://www.ncbi.nlm.nih.gov/pubmed/25265909
- 285 cases
- About 1/3 of cancer victims had no pain
Of those in pain almost 2/3 were nociceptive with:
- 20% neuropathic and 17.5% mixed – a little over 1/3 having some neuropathic features
Reliability ratings:
- sensitivity – 87.5% for DN4 versus 68.1% for LANSS .
- specificity – 93.4% for LANSS versus 88.4% for DN4.
The DN4 is available easily on the web. Here is one version I saw:
Diagnosing Neuropathic Pain – DN4 Questionnaire
Please complete this questionnaire by ticking one answer for each item in the 4 questions below.
Question 1: Does the pain have one or more of the following characteristics?
| 1: Burning | Yes | No |
| 2: Painful Cold | Yes | No |
| 3: Electric Shocks | Yes | No |
Question 2: Is the pain associated with one or more of the following symptoms in the same area?
| 4: Tingling | Yes | No |
| 5: Pins and Needles | Yes | No |
| 6: Numbness | Yes | No |
| 7: Itching | Yes | No |
Examination Of The Patient
Question 3: Is the pain located in an area where the physical examination may reveal one or more of the following characteristics?
| 8: Hypoesthesia to touch | Yes | No |
| 9: Hypoesthesia to prick | Yes | No |
Question 4: In the painful area, can the pain be caused or increased by:
| 10: Brushing ? | Yes | No |
TO COLLATE:
- Score 1 to each YES answer
- Score 0 to each NO answer
- If the score is 4 or higher then the pain is likely to be neuropathic pain.
- If the score is less than 4 then the pain is unlikely to be neuropathic pain
It relies heavily on
- neuropathic pain (burning, painful cold)
- neuralgic pain (shooting)
- nerve loss(tingling, pins and needles and finding of numb patches on touching or pricking)
- Hyperpathia – a form or hypersensitivity that is painful – a painful sensation to brushing
Another recent study got similar results:
Comparing the DN4 tool with the IASP grading system for chronic neuropathic pain screening after breast tumor resection with and without paravertebral blocks: a prospective 6-month validation study
Faraj W. Abdallah et al
Pain 156(4) (2015) 740–74
http://journals.lww.com/pain/Abstract/2015/04000/Comparing_the_DN4_tool_with_the_IASP_grading.21.aspx
- DN4 estimated at 90% sensitivity and 60% specificity
Comment – I have always been a bit uncomfortable requiring numbness in cases in which pain is severe but it is my number one scale now. However not all cases are going to be neuropathic