Abstract Background The identification of a neuropathic component to subacromial pain may lead to different pain management strategies. The purpose of this study was to adapt the Dutch modified painDETECT mPDQ-NL Knee, which discriminates between nociceptive and neuropathic pain, to fit patients with subacromial pain syndrome and subsequently assess its validity and reliability. Regarding reliability, internal consistency was determined and the mPDQ-NL Shoulder was assessed a second time with a two-week interval to determine measurement error and reliability. Results A total of patients were included in the validity analysis and 58 in the reliability analysis. Whether it may also be used as a tool to record change over time or after treatment has to be further assessed. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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PainDETECT: a suitable screening tool for neuropathic pain in patients with painful post-traumatic trigeminal nerve injuries? A prospective cohort of patients with clinically diagnosed neuropathy was given the PD-Q at their clinic appointment, or it was sent to them after their consultation. There was a significant association between PD-Q scores and pain intensity levels across the sample, with those classified as likely NeP reporting high levels of pain.
Chronic pain pain of more than 3-month duration can be a lasting problem for patients with iatrogenic inferior alveolar nerve injury IANI or lingual nerve injury LNI. The most common causes of these injuries include third molar surgery, routine exodontia, complications of root canal treatment, and the placement of dental implants.
While increasing evidence supports abnormal central pain processing in chronic cases, the diagnosis of NeP remains clinical, based on a characteristic symptom profile e. The PD-Q has subsequently been translated into 22 languages, with various forms of delivery for a review, see Bennett et al. In orofacial pain conditions, the diagnosis of NeP remains challenging, predominantly because of the absence of associated clinical and radiographic abnormalities.
Although confirmation of NeP in orofacial pain conditions can be made with some existing neurological tests, these tests have reduced accuracy in identifying subtle neuronal abnormalities and tend to be costly. Further, quantitative sensory testing QST , which depends on expensive equipment and is time-consuming, is not always helpful in the differential diagnosis; and QST abnormalities cannot be taken as a conclusive demonstration of neuropathic pain.
Thus, there is a significant need in this clinical population for efficient screening methods or tools providing a systematic approach to assessing NeP. A simple questionnaire-based measure, such as the PD-Q, has the potential to alleviate some of the financial burden and impact of persistent pain by early identification in neuropathic conditions, and thus may facilitate more timely administration of appropriate therapy.
In line with the further development of effective screening tools that can be utilized easily in the clinical arena in an accurate and cost-effective manner, the rationale for this study was to explore for the first time, whether or not the PD-Q is a useful tool for identifying NeP elements in two different known nerve injuries of the orofacial region.
Materials and methods Design This was an observational clinical study assessing the suitability of using the PD-Q to screen for neuropathic pain components amongst patients with iatrogenic nerve injury. Participants A prospective cohort of patients with clinically diagnosed neuropathy was given the PD-Q at their clinic appointment, or it was sent to them after their consultation. Patients were included in the study if they presented to the clinic with reported sensory changes due to iatrogenic IANI or LNI, and could read and write in English sufficiently well to complete the questionnaire.
The clinical diagnosis of neuropathic pain was ascertained by obtaining a pain history from each patient and confirming allodynia, hyperalgesia, or spontaneous neuropathic pain using several clinical neurosensory tests, as well as by recording the fact that their pain was unresponsive to non-steroidal anti-inflammatory drugs. The pain was recorded within a proven area of focal neuropathy corresponding to the trigeminal nerve branch damaged by the surgical intervention.
Prior to completing the PD-Q, all patients underwent a trigeminal nerve examination carried out by the principal investigator which included a series of neurosensory tests , whereby trigeminal nerve injury was confirmed and neuropathy was diagnosed. Patients were excluded if they had chronic orofacial pain caused by other conditions. This study had the required ethical approval. The PD-Q also contains nine other items, of which seven relate to sensory responses and two to the temporal and spatial characteristics of the pain pattern.
The online version of the questionnaire is available at: www. Statistical analysis Summary statistics for the overall sample and for the IANI and LNI patient subgroups were calculated and presented in the form of means and standard deviations for quantitative variables, and frequencies and percentages for qualitative variables.
Associations between PD-Q NeP classifications and measures of pain intensity current, 4-week strongest, and 4-week average strength were evaluated considering the whole sample by one-way ANOVA models with post hoc pairwise examinations for significant results.
Results Sample characteristics Altogether, 91 patients completed the PD-Q, 16 at their clinic appointment and 75 via questionnaires posted to them after their consultation.
Most patients were female The mean duration of nerve injury was Table 1 Only gold members can continue reading. Log In or Register to continue You may also need.
Measurement properties of painDETECT by average pain severity
In other words, it is a simple bedside test, conducted in two parts. The primary purpose of this test is to assess whether the pain experienced is predominantly due to nerve damage or not. The LANSS scale is the only published tool with validity for discriminating between neuropathic and nociceptive pain, regardless if the disease-based diagnostic methods. However, it important to note that the purpose of this test is to assist the clinicians in assessing the severity of the pain or its causes. According to various research reports, these LANSS tests correctly classified the patients as suffering from nociceptive and neuropathic pain, in four out of every five patients experiencing chronic pain. Would you describe your pain as strange unpleasant sensations in your skin? A patient with a score of 12 or more on this scale is diagnosed as suffering from neuropathic pain to some degree.
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)
Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. This article has been cited by other articles in PMC. Abstract Background Since the burden of neuropathic pain NeP increases with pain severity, it is important to characterize and quantify pain severity when identifying NeP patients. The ability of painDETECT to discriminate average pain-severity levels, based on the average pain item from the Brief Pain Inventory — Short Form 0—10 scale , was evaluated using analysis of variance or covariance models to obtain unadjusted and adjusted age, sex, race, ethnicity, time since NeP diagnosis, number of comorbidities mean painDETECT scores. Results Unadjusted mean scores were Adjusted nine-item mean scores for mild, moderate, and severe pain were Conclusion This study provides strong psychometric evidence on the validity and reliability of painDETECT for distinguishing average pain severity in patients with NeP.