Korean J Pain.  2017 Jul;30(3):197-206. 10.3344/kjp.2017.30.3.197.

Hindi version of short form of douleur neuropathique 4 (S-DN4) questionnaire for assessment of neuropathic pain component: a cross-cultural validation study

• Gudala K
• Ghai B
• Bansal D

• KMID: 2385352
• DOI: http://doi.org/10.3344/kjp.2017.30.3.197

Abstract

BACKGROUND
Pain with neuropathic characteristics is generally more severe and associated with a lower quality of life compared to nociceptive pain (NcP). Short form of the Douleur Neuropathique en 4 Questions (S-DN4) is one of the most used and reliable screening questionnaires and is reported to have good diagnostic properties. This study was aimed to cross-culturally validate the Hindi version of the S-DN4 in patients with various chronic pain conditions.
METHODS
The S-DN4 is already translated into the Hindi language by Mapi Research Trust. This study assessed the psychometric properties of the Hindi version of the S-DN4 including internal consistency and test-retest reliability after 3 days' post-baseline assessment. Diagnostic performance was also assessed.
RESULTS
One hundred sixty patients with chronic pain, 80 each in the neuropathic pain (NeP) present and NeP absent groups, were recruited. Patients with NeP present reported significantly higher S-DN4 scores in comparison to patients in the NeP absent group (mean (SD), 4.7 (1.7) vs. 1.8 (1.6), P < 0.01). The S-DN4 was found to have an AUC of 0.88 with adequate internal consistency (Cronbach's α = 0.80) and a test-retest reliability (ICC = 0.92) with an optimal cut-off value of 3 (Youden's index = 0.66, sensitivity and specificity of 88.7% and 77.5%). The diagnostic concordance rate between clinician diagnosis and the S-DN4 questionnaire was 83.1% (kappa = 0.66).
CONCLUSIONS
Overall, the Hindi version of the S-DN4 has good internal consistency and test-retest reliability along with good diagnostic accuracy.

Keyword

Mass screening; Neuralgia; Neuropathic pain; Nociceptive pain; Patient reported outcome measures; Surveys and questionnaires

MeSH Terms

Area Under Curve
Chronic Pain
Diagnosis
Humans
Mass Screening
Neuralgia*
Nociceptive Pain
Psychometrics
Quality of Life
Reproducibility of Results
Sensitivity and Specificity
Surveys and Questionnaires

Figure

• 

  Fig. 1 (A) Receiver operating characteristic curve of S-DN4 questionnaire vs. clinician diagnosis to detect NeP in patients with chronic pain; AUC 0.88 (95% CI, 0.81–0.92; P < 0.01). (B) Plot representing change in sensitivity and specificity according to the overall S-DN4.

Reference

1. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008; 70:1630–1635. PMID: 18003941.

2. Hiyama A, Watanabe M, Katoh H, Sato M, Sakai D, Mochida J. Evaluation of quality of life and neuropathic pain in patients with low back pain using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire. Eur Spine J. 2015; 24:503–512. PMID: 25502001.

3. Freynhagen R, Baron R. The evaluation of neuropathic components in low back pain. Curr Pain Headache Rep. 2009; 13:185–190. PMID: 19457278.

4. Yamashita T, Takahashi K, Yonenobu K, Kikuchi S. Prevalence of neuropathic pain in cases with chronic pain related to spinal disorders. J Orthop Sci. 2014; 19:15–21. PMID: 24306580.

5. Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain. 2006; 7:281–289. PMID: 16618472.

6. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008; 136:380–387. PMID: 17888574.

7. Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006; 22:1911–1920. PMID: 17022849.

8. Boureau F, Doubrère JF, Luu M. Study of verbal description in neuropathic pain. Pain. 1990; 42:145–152. PMID: 2247313.

9. Dubuisson D, Melzack R. Classification of clinical pain descriptions by multiple group discriminant analysis. Exp Neurol. 1976; 51:480–487. PMID: 1269574.

10. Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, et al. Using screening tools to identify neuropathic pain. Pain. 2007; 127:199–203. PMID: 17182186.

11. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005; 114:29–36. PMID: 15733628.

12. Harifi G, Ouilki I, El Bouchti I, Ouazar MA, Belkhou A, Younsi R, 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 Pract. 2011; 11:139–147. PMID: 20602717.

13. Chatila N, Pereira B, Maarrawi J, Dallel R. Validation of a new Arabic version of the neuropathic pain diagnostic questionnaire (DN4). Pain Pract. 2017; 17:78–87. PMID: 26895970.

14. van Seventer R, Vos C, Giezeman M, Meerding WJ, Arnould B, Regnault A, et al. Validation of the Dutch version of the DN4 diagnostic questionnaire for neuropathic pain. Pain Pract. 2013; 13:390–398. PMID: 23113981.

15. De Andrés J, Pérez-Cajaraville J, Lopez-Alarcón MD, López-Millán JM, Margarit C, Rodrigo-Royo MD, et al. Cultural adaptation and validation of the painDETECT scale into Spanish. Clin J Pain. 2012; 28:243–253. PMID: 21926908.

16. Sykioti P, Zis P, Vadalouca A, Siafaka I, Argyra E, Bouhassira D, et al. Validation of the Greek version of the DN4 diagnostic questionnaire for neuropathic pain. Pain Pract. 2015; 15:627–632. PMID: 24796220.

17. Padua L, Briani C, Truini A, Aprile I, Bouhassirà D, Cruccu G, et al. Consistence and discrepancy of neuropathic pain screening tools DN4 and ID-Pain. Neurol Sci. 2013; 34:373–377. PMID: 22434411.

18. Kim HJ, Park JH, Bouhassira D, Shin JH, Chang BS, Lee CK, et al. Validation of the Korean version of the DN4 diagnostic questionnaire for neuropathic pain in patients with lumbar or lumbar-radicular pain. Yonsei Med J. 2016; 57:449–454. PMID: 26847299.

19. Madani SP, Fateh HR, Forogh B, Fereshtehnejad SM, Ahadi T, Ghaboussi P, et al. Validity and reliability of the persian (Farsi) version of the DN4 (Douleur Neuropathique 4 Questions) questionnaire for differential diagnosis of neuropathic from non-neuropathic pains. Pain Pract. 2014; 14:427–436. PMID: 23763722.

20. Santos JG, Brito JO, de Andrade DC, Kaziyama VM, Ferreira KA, Souza I, et al. Translation to Portuguese and validation of the Douleur Neuropathique 4 questionnaire. J Pain. 2010; 11:484–490. PMID: 20015708.

21. Perez C, Galvez R, Huelbes S, Insausti J, Bouhassira D, Diaz S, 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. 2007; 5:66. PMID: 18053212.

22. 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. 2010; 11:1129–1135. PMID: 20418179.

23. Chaudakshetrin P, Prateepavanich P, Chira-Adisai W, Tassanawipas W, Leechavengvongs S, Kitisomprayoonkul W. Cross-cultural adaptation to the Thai language of the neuropathic pain diagnostic questionnaire (DN4). J Med Assoc Thai. 2007; 90:1860–1865. PMID: 17957931.

24. Cruccu G, Truini A. Tools for assessing neuropathic pain. PLoS Med. 2009; 6:e1000045. PMID: 19360134.

25. Li J, Feng Y, Han J, Fan B, Wu D, Zhang D, et al. Linguistic adaptation, validation and comparison of 3 routinely used neuropathic pain questionnaires. Pain Physician. 2012; 15:179–186. PMID: 22430656.