• Øystein Dunker, Margreth Grotle, Bu KvaløyMarieMSection of Clinical Neurophysiology, Department of Neurology, Stavanger University Hospital, Stavanger, Norway., Martin Uglem, Sissel Løseth, Ina Elen Hjelland, Inge Petter Kleggetveit, Sara Maria Allen, Dehli VigelandMariaMResearch and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway., Munk KillingmoRikkeRDepartment of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway., Trond Sand, and Kristian Bernhard Nilsen.
• Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.
• Pain. 2023 May 1; 164 (5): 9911001991-1001.

AbstractPain is a common symptom in patients referred to polyneuropathy assessment. Diagnostic evaluation and choice of treatment may depend on whether the pain is likely to be neuropathic or not. This study aimed to investigate the diagnostic accuracy of 3 tools commonly used to differentiate between neuropathic and nonneuropathic pain. To accomplish this, we included patients with bilateral distal lower extremity pain, referred to neurological outpatient clinics at 5 Norwegian University hospitals for polyneuropathy assessment. The patients filled in Norwegian versions of painDETECT, the Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), and the clinician-rated Douleur Neuropathique 4 (DN4). All patients underwent a clinical examination and nerve conduction measurements and were classified according to the NeuPSIG neuropathic pain criteria (reference standard). In total, 729 patients were included, of which 63% had neuropathic pain by the reference standard. Only DN4 demonstrated high sensitivity (0.87), whereas all 3 tools had low specificity (≤0.65). Importantly, the tools' predictive ability was unsatisfactory; The probability of getting a correct test result was 3 quarters at best, and at worst, no better than two fifths. Consequently, we show that neither DN4, painDETECT, nor S-LANSS can be confidently used to assess neuropathic pain in a neurological outpatient population with symptoms of polyneuropathy.Copyright © 2022 International Association for the Study of Pain.

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