Clinical and Research Applications of Screening and Assessment Questionnaires for Neuropathic Pain

Screening and assessment questionnaires administered to patients with neuropathic pain are valid tools that help further understanding of subjective neuropathic pain symptoms while assisting in routine monitoring and prediction of treatment response and outcomes, according to a review published in Lancet Neurology.

At this time, a total of 2 questionnaire types have been validated for diagnosis and management of neuropathic pain symptoms: screening and assessment questionnaires. The Leeds Assessment of Neuropathic Symptoms and Signs, the Neuropathic Pain Questionnaire, the Douleur Neuropathique en 4 Questions (DN4), PainDETECT, and ID Pain represent the currently validated screening questionnaires based largely on verbal pain descriptors (eg, pins and needles, burning pain, electric shocks, etc) for research and clinical practice. In addition, the Neuropathic Pain Scale, the Neuropathic Pain Symptom Inventory, the Pain Quality Assessment Scale, and the McGill Short-Form Questionnaire 2 are validated assessment questionnaires that quantify neuropathic symptoms on categorical or numerical scales.

Screening questionnaires can be administered by specialists and nonspecialists, which widens their applicability and subsequently affects pain management. Specific countries officially recommend some screening questionnaires for the early assessment of neuropathic pain, with France recommending the DN4 and Germany recommending PainDETECT. Self-reported screening questionnaires, because of their high level of sensitivity and specificity, are most appropriate for use in large-scale epidemiological studies for evaluation of neuropathic pain prevalence.

Despite the ability of screening questionnaires to accurately identify pain symptoms and help stratify patients to appropriate therapy, some limitations do exist. For instance, they offer little insight into the pain’s history, nor do they identify the source of pain in every circumstance. As such, screening questionnaires are suggested to be only “the first step in the diagnostic workup for the identification of neuropathic pain.”

Sensory descriptors are used in assessment questionnaires and are often grouped into combinations or dimensions of symptoms. Overall, these types of questionnaires provide reliable insight into the nature of neuropathic pain symptoms and allow for monitoring of treatment response and outcomes. Relevant descriptors for neuropathic pain, such as heat-associated pain or numbness, can be missed by assessment questionnaires, potentially limiting their utility in neuropathic pain management. Pathophysiological studies are often the primary research areas in which assessment questionnaires are used.

“The development and widespread use of clinical questionnaires for neuropathic pain, and their validation in several languages, show that subjective pain assessments are essential for diagnosis and assessment of neuropathic pain,” the investigators added, “despite the availability of increasingly sophisticated methods to assess nerve lesions.”

Reference

Attal N, Bouhassira D, Baron R. Diagnosis and assessment of neuropathic pain through questionnaires. Lancet Neurol. 2018;17(5):456-466.