Abstract
BACKGROUND: Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system and is a major therapeutic challenge. Several screening tools have been developed to help physicians detect patients with neuropathic pain. These have typically been validated in populations pre-stratified for neuropathic pain, leading to a so called "Catch-22 situation:" "a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule". The validity of screening tools needs to be proven in patients with pain who were not pre-stratified on basis of the target outcome: neuropathic pain or non-neuropathic pain. This study aims to assess the validity of the Dutch PainDETECT (PainDETECT -Dlv) in a large population of patients with chronic pain.
METHODS: A cross-sectional multicentre design was used to assess PainDETECT -Dlv validity. Included where patients with low back pain radiating into the leg(s), patients with neck-shoulder-arm pain and patients with pain due to a suspected peripheral nerve damage. Patients' pain was classified as having a neuropathic pain component (yes/no) by two experienced physicians ("gold standard"). Physician opinion based on the Grading System was a secondary comparison.
RESULTS: In total, 291 patients were included. Primary analysis was done on patients where both physicians agreed upon the pain classification (n = 228). Compared to the physician's classification, PainDETECT -Dlv had a sensitivity of 80% and specificity of 55%, versus the Grading System it achieved 74 and 46%.
CONCLUSION: Despite its internal consistency and test-retest reliability the PainDETECT -Dlv is not an effective screening tool for a neuropathic pain component in a population of patients with chronic pain because of its moderate sensitivity and low specificity. Moreover, the indiscriminate use of the PainDETECT -Dlv as a surrogate for clinical assessment should be avoided in daily clinical practice as well as in (clinical-) research. Catch-22 situations in the validation of screening tools can be prevented by not pre-stratifying the patients on basis of the target outcome before inclusion in a validation study for screening instruments.
TRIAL REGISTRATION: The protocol was registered prospectively in the Dutch National Trial Register: NTR 3030 .
Originalsprog | Engelsk |
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Artikelnummer | 91 |
Tidsskrift | BMC Neurology |
Vol/bind | 18 |
Udgave nummer | 1 |
Antal sider | 14 |
ISSN | 1471-2377 |
DOI | |
Status | Udgivet - 29 jun. 2018 |
Fingeraftryk
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Avoiding Catch-22: validating the PainDETECT in a in a population of patients with chronic pain
Timmerman, H. (Ophavsperson), Wolff, A. P. (Ophavsperson), Bronkhorst, E. M. (Ophavsperson), Wilder-Smith, O. H. G. (Ophavsperson), Schenkels, M. J. (Ophavsperson), van Dasselaar, N. T. (Bidrager), Huygen, F. J. P. M. (Ophavsperson), Steegers, M. A. H. (Ophavsperson) & Vissers, K. C. P. (Ophavsperson), Figshare, 2018
DOI: 10.6084/m9.figshare.c.4150352.v1, https://figshare.com/collections/Avoiding_Catch-22_validating_the_PainDETECT_in_a_in_a_population_of_patients_with_chronic_pain/4150352/1
Datasæt
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Avoiding Catch-22: validating the PainDETECT in a population of patients with chronic pain
Timmerman, H. (Ophavsperson), Wolff, A. P. (Ophavsperson), Bronkhorst, E. M. (Ophavsperson), Wilder-Smith, O. H. G. (Ophavsperson), Schenkels, M. J. (Ophavsperson), van Dasselaar, N. T. (Bidrager), Huygen, F. J. P. M. (Ophavsperson), Steegers, M. A. H. (Ophavsperson) & Vissers, K. C. P. (Ophavsperson), Figshare, 2018
DOI: 10.6084/m9.figshare.c.4150352.v2, https://figshare.com/collections/Avoiding_Catch-22_validating_the_PainDETECT_in_a_in_a_population_of_patients_with_chronic_pain/4150352/2
Datasæt
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Avoiding Catch-22: validating the PainDETECT in a population of patients with chronic pain
Timmerman, H. (Ophavsperson), Wolff, A. P. (Ophavsperson), Bronkhorst, E. M. (Ophavsperson), Wilder-Smith, O. H. G. (Ophavsperson), Schenkels, M. J. (Ophavsperson), van Dasselaar, N. T. (Bidrager), Huygen, F. J. P. M. (Ophavsperson), Steegers, M. A. H. (Ophavsperson) & Vissers, K. C. P. (Ophavsperson), Figshare, 2018
DOI: 10.6084/m9.figshare.c.4150352, https://figshare.com/collections/Avoiding_Catch-22_validating_the_PainDETECT_in_a_in_a_population_of_patients_with_chronic_pain/4150352
Datasæt