Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden Department of Neuroscience, Uppsala University, Section of Physiotherapy, Uppsala, Sweden.
Pain. 2011 Apr;152(4):772-779. doi: 10.1016/j.pain.2010.11.019. Epub 2011 Jan 26.
Pain of both neuropathic and nociceptive aetiology is common after spinal cord injury (SCI), and classifying pain is sometimes a challenge. The objective of this study was to test the usefulness of the Swedish version of the screening tools Douleur Neuropathique 4 questions (DN4), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Neuropathic Pain Questionnaire (NPQ), and the painDETECT Questionnaire (PD-Q) in individuals with SCI and pain. A further objective was to define pain descriptors able to discriminate neuropathic pain from nonneuropathic pain. Forty individuals with SCI ≥1 year and pain ≥6 months were examined by a specialised physician and assessed twice using the 4 screening tools. The analysis included tests of reliability (test-retest) and validity (calculation of sensitivity, specificity, and overall agreement), an explorative analysis of the cutoff scores and regression analysis for identifying predictors of diagnostic accuracy. Our results indicate that reliability was good to very good for 3 of the screening tools, DN4, LANSS, and NPQ with a Cohen's kappa coefficient between 0.70 and 1.00. DN4 showed the highest sensitivity (93%), followed by PD-Q (68%), NPQ (50%), and LANSS (36%). LANSS and NPQ demonstrated the highest specificity (100%), followed by PD-Q (83%) and DN4 (75%). Diagnostic accuracy for the tools was for DN4 88%, PD-Q 78%, NPQ 65%, and LANSS 55%. A final model showed that 3 items, hypoesthesia to touch, burning pain, and numbness, could discriminate pain in this cohort of individuals with SCI with a high goodness of fit.
脊髓损伤（SCI）后常出现神经病理性和伤害感受性疼痛，有时对疼痛进行分类具有挑战性。本研究旨在测试瑞典版筛查工具——4 个问题的神经性疼痛筛查工具（DN4）、利兹神经病症状和体征评估（LANSS）、神经性疼痛问卷（NPQ）和疼痛 DETECT 问卷（PD-Q）在 SCI 伴疼痛患者中的有效性。进一步的目的是确定能够区分神经病理性疼痛和非神经病理性疼痛的疼痛描述符。40 名 SCI 病程≥1 年且疼痛持续≥6 个月的患者接受了专科医生的检查，并使用这 4 种筛查工具进行了两次评估。分析包括可靠性（测试-重测）和有效性（计算敏感性、特异性和总体一致性）测试，对截断值进行探索性分析以及回归分析以确定诊断准确性的预测因子。我们的结果表明，DN4、LANSS 和 NPQ 这 3 种筛查工具的可靠性良好至非常好，Cohen's kappa 系数在 0.70 到 1.00 之间。DN4 的敏感性最高（93%），其次是 PD-Q（68%）、NPQ（50%）和 LANSS（36%）。LANSS 和 NPQ 的特异性最高（100%），其次是 PD-Q（83%）和 DN4（75%）。这 4 种工具的诊断准确性为：DN4 为 88%，PD-Q 为 78%，NPQ 为 65%，LANSS 为 55%。最终模型显示，3 项指标（触觉减退、烧灼感和麻木感）可以区分 SCI 患者的疼痛，拟合优度高。
