The Journal of Pain, Vol 11, No 11 (November), 2010: pp 1129-1135

Available online at www.sciencedirect.com

A Comparison of the DN4 and LANSS Questionnaires in the

Assessment of Neuropathic Pain: Validity and Reliability of the
Turkish Version of DN4

Isin Unal-Cevik,* Saime Sarioglu-Ay,y and Deniz Evciky

* Ufuk University Faculty of Medicine, Department of Neurology, Ankara, Turkey.
y
Ufuk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey.

Abstract: A screening tool that quickly and correctly differentiates neuropathic pain from non-
neuropathic pain is essential. Although there are many screening tools in the assessment of neuro-
pathic pain, many physicians still have the problem of not being able to identify their neuropathic
pain patients easily. In this study, we assessed the test-retest reliability, internal consistency, and val-
idity of the Turkish version of DN4 questionnaire. Within the same group of patients, we also com-
pared the DN4 with the LANSS questionnaire. A total of 180 patients (n = 121 with neuropathic
pain and n = 59 with non-neuropathic pain characteristics) were enrolled. In our study population,
peripheral origin of neuropathic pain, mainly radiculopathies and polyneuropathies, dominated.
The reliability and validity of Turkish version of DN4 were found to be high. The sensitivities of
the DN4 and the LANSS were 95% and 70.2%, respectively. The specificity of both tests was
96.6%. The strengths and weaknesses of these questionnaires are discussed.
Perspective: The Turkish version of DN4 questionnaire is reliable and valid. It is also an easier,
quicker, and more sensitive screening tool (1-minute test) compared with the Turkish version of
LANSS questionnaire. These features of the DN4 may help clinicians to identify their neuropathic
pain patients accurately in daily clinical practice and research studies.
ª 2010 by the American Pain Society
Key words: Neuropathic pain, non-neuropathic pain, visual analog scale, pain assessment, screening
tool.

A
group of experts from the neurology and pain sometimes as dull, aching, pressure, squeezing, deep,
community has redefined neuropathic pain as: cold pain, and neuropathic itch.5,16,17 The estimated
‘‘Pain arising as a direct consequence of a lesion prevalence of neuropathic pain characteristics in the
or disease affecting the somatosensory system.’’26 How- general population may be as high as 7%.7 However,
ever, the diagnosis of neuropathic pain is still challenging. many physicians still have the problem of not being
A working grading system includes a history of pain sug- able to identify neuropathic pain patients.15 Without an
gesting a neuroanatomically relevant lesion or disease, appropriate suspicion of neuropathic pain, many patients
examination of negative or positive sensory signs con- are under the burden of productivity loss and/or loss of
fined to the innervation territory of the nervous system desire to live and are to be faced with inappropriate or
with any diagnostic test confirming a lesion or disease under-treatment. Besides, there is an unnecessary occupa-
to explain the neuropathic pain.26 Symptamatology of tion of higher-level health care systems with the same
neuropathic pain includes spontaneous or trigger- pain complaints, which all result in a huge economic
induced chronic pain, characteristically burning, stab- loss for the country.
bing, electric-like shocks, sharp, shooting, lancinating or The first suspicion of neuropathic pain can be identi-
fied by screening tools. In literature, screening tools to
Received December 17, 2009; Revised February 4, 2010; Accepted identify neuropathic pain have been developed since
February 10, 2010.
The authors report no conflicts of interest.
2001.4 There are many reported screening tools (LANSS,
Address reprint requests to Dr Isin Unal-Cevik, Ufuk University, Faculty of DN4, NPQ, PainDETECT, ID-pain, StEP questionnaire and
Medicine, Department of Neurology, Balgat, 06520-Ankara, Turkey. etc) to identify neuropathic pain.1,3,6,13,21,22 Recently,
E-mail: [email protected]
1526-5900/$36.00 an expanded and revised form of Short-form McGill
ª 2010 by the American Pain Society Pain Questionnaire (SF-MPQ-2) has been validated in
doi:10.1016/j.jpain.2010.02.003 neuropathic pain patients as well.11 The SF-MPQ-2

1129
1130 The Journal of Pain DN4 and LANSS Scales in the Assessment of Neuropathic Pain
questionnaire has the advantage of evaluating the pain culture were decided by the authors. The questionnaire
intensity as well as measuring sensory, affective, and was tested to a pilot group of 30 patients with pain com-
evaluative qualities of pain. The response to treatment plaints who were asked to report any difficulty in both
may also be assessed.11 Based on pain symptoms and clin- meaning and conceptual framework of the question-
ical examinations, all screening tools have strengths and naire. Finally, the last revision was made to assess the
weaknesses.4,10 The strength of the ID-pain scale is to as- clarity or appropriateness of wording of the translated
sesses pain limited to joints (used to identify non- questionnaire (see Appendix B). The investigators in-
neuropathic pain); pain-DETECT assesses radiation of volved in this study were a neurologist and pain specialist
pain and pain evoked by mild pressure, heat, or cold; (I.U.C.) and physiatrists (S.S.A. and D.E.). The study was
NPQ assesses pain evoked by changes in weather; LANSS conducted in Ufuk University Faculty of Medicine, De-
assesses autonomic changes; and DN4 assesses both itch- partments of Neurology and Physical Medicine and Re-
ing and raised soft touch threshold.4 A recently reported habilitation. One of the authors (I.U.C.) also recruited
screening tool to differentiate radicular back pain from patients from Medicana International Ankara Hospital
axial low back pain is named StEP (Standardized Evalua- Pain Center.
tion of Pain).22 All screening tools have self-assessment
questions. However, sensory examination is present in Patients
LANSS, DN4, and StEP questionnaires, which give them
Patients aged over 18, having a chief pain complaint in
an objective significance and crucial findings for the
1 anatomical location, either diagnosed to have neu-
diagnosis of neuropathic pain, among all the others.
ropathic pain (NP) or non-neuropathic pain (NNP) were
The DN4 questionnaire (Douleur Neuropathique 4
included. Patients who had an adequate level of under-
questions) was originally developed and validated by
standing of the questionnaire were enrolled and written
a French group of experts.6 Linguistic validation of the
informed consents were obtained. The Turkish version of
DN4 for use in international studies has been reported
the DN4 questionnaire was administered to the same pa-
as well.27 In this study, we aimed to assess the validity
tient twice, 2 days apart, by the same investigator. Differ-
and reliability of the Turkish version of the DN4 question-
ential diagnosis of patients with neuropathic pain was
naire and whether it is an easy and accurate screening
based on medical history, clinical examinations, and ap-
tool to identify neuropathic pain patients. This may en-
propriate diagnostic techniques including neuroimaging
able us to identify very quickly and standardize the neu-
and electrophysiological studies when indicated. The pa-
ropathic pain patients in daily clinical practice and in
tients diagnosed to have definite or probable neuro-
research studies. Within the same group of patients, we
pathic pain were included for data analysis.26 Patients
also wanted to compare the strengths or weaknesses of
with possible neuropathic pain were not included in
the DN4 questionnaire with the LANSS questionnaire.
the study. The musculoskeletal and neurological exami-
nations of the patients with cervical and lumbar pain
Materials and Methods were performed appropriately. Only the patients whose
main clinical findings were consistent with radiculopathy
The DN4 questionnaire consists of 10 items.6 The first 7 (characterized by radicular pain toward the affected
items are related to pain characteristics and sensations limb and clinical signs of nerve root involvement, includ-
and the remaining 3 items are related to the ing sensory or motor deficits in the limb and a diminution
examination (see Appendix A). For each item, a score or loss of tendon reflexes) were enrolled in neuropathic
of ‘‘1’’ is given if the answer is ‘‘yes’’ and a score of ‘‘0’’ pain group. The non-neuropathic pain group included
is given if it is ‘‘no.’’ The patient is defined to have neuro- osteoarthritis, mechanical low back pain (defined as axial
pathic pain if the sum of all 10 items is calculated to be 4 pain accompanied by limitation of the range of motion
or more.6 in the neck or low back area without any sign of radicul-
opathy), myofascial pain syndrome, carpal tunnel syn-
Adaptation Procedure Into Turkish of the drome (defined as mild paresthesia and indistinct
DN4 Questionnaire discomfort present only at night), and somatoform disor-
ders. A detailed form that included the demographic
After approval of the study by the local ethics commit-
characteristics of the patient and clinical characteristics
tees (applied by one of the authors [I.U.C.] to both Ufuk
of their pain assessed by 10-cm visual analog scale
University Faculty of Medicine Local Ethics Committee
(VAS) and the duration and ease of use of DN4 and LANSS
and Medicana International Ankara Hospital Local Ethics
questionnaires was filled by the physician. The physician
Committee), the DN4 was adapted to Turkish population
recorded the time consumed in filling both question-
using recommended guidelines for cross-cultural adap-
naires by a stop watch.
tation.2 Initially the English questionnaire was translated
into Turkish by 4 native Turkish-speaking physicians, an
expert engineer in methodology, and an English linguist Statistics
(forward translation). The Turkish questionnaire was For the statistical analysis, SPSS for Windows Release
back-translated into English by a native English speaker 16.0 (SPSS Inc, Chicago, IL) was used. All data for normal-
who spoke Turkish fluently and did not see the original ity was tested by using the Kolmogorov-Smirnov test. To
questionnaire. Later, the Turkish translations of most compare the differences between the groups, the Mann-
accurate, understandable, and compatible to Turkish Whitney U test was used.
Unal-Cevik, Sarioglu-Ay, and Evcik The Journal of Pain 1131
Reliability Demographic Data of the Neuropathic
Table 1.
Reliability of the Turkish version of the DN4 was tested and Non-Neuropathic Pain Patients
by internal consistency and test-retest reliability. Test-
NP (N = 121) NNP (N = 59) P VALUE
retest reliability gives an opinion that there has been
no change in condition between 2 successive administra- Age (y) 53.3 6 14.1 48.7 6 13.1 .035
Sex (female/male) 78/43 34/25 .376
tions. It was evaluated by using intraclass correlation co-
BMI (kg/m2) 76.3 6 15.1 73.4 6 15.5 .603
efficient (ICC) with 95% confidence interval, ranged
Education level n, (%) .126
between 0 and 1, and the results over 0.70 were accepted Low (#8 y) 66 (54.6%) 25 (42.4%)
adequate for reliability.12,18,19 Internal consistency High (>8 y) 55 (45.4%) 34 (67.6%)
determines the homogeneity of the subscale and it Occupation n, (%) .436
can also be described as intercorrelation of the items Employed 69 (57.0%) 30 (50.9%)
in an instrument and was expressed by Cronbach’s Unemployed 52 (43.0%) 29 (49.1%)
a coefficient.9 Cronbach’s a coefficient ranges from 0 to Drug therapy n, (%) .259
1, and higher values indicate higher internal consistency Medication 86 (71.1%) 37 (62.7)
reliability.9,12 (for pain relief)
No medication 35 (28.9%) 22 (37.3%)
(for pain relief)
Validity Patients’ global VAS 5.3 6 1.6 4.7 6 1.5 .002
Validity was assessed by construct validity, ROC (re- assessment
ceiver operating characteristic), AUC (area under the Physicians’ global VAS 5.9 6 1.7 5.0 6 1.9 .023
curve), along with sensitivity and specificity.25 Construct assessment
validity was determined by testing for expected associa-
BMI, body mass index; NP, pain associated with neuropathic pain component;
tions between the adapted instrument and other valid NNP, pain associated with non-neuropathic pain component; VAS, visual analog
measures. Spearman correlation coefficient2 was used scale (0 to 10).
for statistical analysis. Construct validity was evaluated
with correlation between Turkish LANSS question-
ported to be statistically significant in neuropathic pain
naire.28 ROC curve analysis was used to determine the
patients compared to non-neuropathic pain patients
cut-off value of the questionnaire score for neuropathic
(all P < .05). The prominent sensory descriptive of DN4
pain diagnosis. The AUC was calculated by the trapezoid
questionnaire in neuropathic pain patients were tin-
method.
gling, burning, pins and needles, electric shocks, painful
cold, and numbness. The least symptom reported was
Results itching (30.6%). On examination hypoesthesia to touch,
hypoesthesia to prick, and brush allodynia was present in
Patient Characteristics more than 50% of neuropathic pain patients and less
A total of 180 patients (n = 121 with neuropathic pain than 5% in non-neuropathic pain patients (P < .05).
characteristics and n = 59 with non-neuropathic pain)
were enrolled to the study. Among the neuropathic
pain patients (n = 121), the definite and probable neuro- Table 2. Etiology of Pain in the Study Patients
pathic pain groups consisted of 71.1% (n = 86) and 28.9%
N (%)
(n = 35), respectively. Demographic and clinical features
of the participants are shown in Table 1. There was no Neuropathic pain (n = 121)
difference in sex, body mass index, educational level, oc- Radiculopathy (cervical or lumbar) 63 (52.1%)
Non-diabetic polyneuropathy 13 (10.7%)
cupation, and presence of the use of any medication to
Diabetic polyneuropathy 12 (9.9%)
relieve pain between the groups. However, neuropathic
Carpal tunnel syndrome 8 (6.6%)
pain patients were slightly older, and VAS scores were Postherpetic neuralgia 5 (4.1%)
higher than the non-neuropathic pain patients (P < Post-surgical pain 5 (4.1%)
.05). The etiology of pain in the study patients is summa- Trigeminal neuralgia 4 (3.3%)
rized in Table 2. Patients with neuropathic pain compo- Medulla spinalis benign lesion 2 (1.7%)
nents consisted of both peripheral and central origin. Spinal stenosis 2 (1.7%)
Non-neuropathic pain patients consisted of those with Post-stroke pain 1 (0.8%)
osteoarthritis (knee and hip), mechanical low back Nerve trauma 1 (0.8%)
pain, myofascial pain syndrome, carpal tunnel syndrome Thoracic outlet syndrome 1 (0.8%)
(without neuropathic pain components), and somato- Neuralgia paresthetica 1 (0.8%)
Occipital neuralgia 1 (0.8%)
form disorders.
Phantom pain 1 (0.8%)
Non-neuropathic pain (n = 59)
Features of NP and NNP According to DN4 Osteoarthritis 27 (45.8%)
Questionnaire Mechanical low back pain 22 (37.3%)
Myofascial pain syndrome 6 (10.2%)
We compared the frequency of positive score for each
Carpal tunnel syndrome 2 (3.3%)
item of the DN4 questionnaire between neuropathic and Somatoform disorder 1 (1.7%)
non-neuropathic patients (Table 3). Each item was re-
1132 The Journal of Pain DN4 and LANSS Scales in the Assessment of Neuropathic Pain
Frequency of the DN4 Questionnaire 10
Table 3.
Items Between Groups
NP NNP
N (%) N (%) P VALUE
Burning 103 (85.1%) 20 (33.9%) .000
Painful cold 67 (55.4%) 9 (15.3%) .000
Electric shocks 94 (77.7%) 7 (11.9%) .000
Tingling 107 (88.4%) 8 (13.6%) .000
Pins and needles 102 (84.3%) 5 (8.5%) .000
Numbness 73 (60.3%) 4 (6.8%) .000
Itching 37 (30.6%) 7 (11.9%) .006
Hypoesthesia to touch 89 (73.6%) 2 (3.4%) .000
Hypoesthesia to prick 64 (52.9%) 3 (5.1%) .000
Brushing 68 (56.2%) 1 (1.7%) .000

Reliability
The DN4 questionnaire was reliable for both neuro-
pathic and non-neuropathic pain patients, with Cron-
bach’s a coefficients of 0.97 and 0.98, respectively (Table
4). Each 10 items of DN4 questionnaire had a Cronbach’s
a coefficient greater than the recommended value (0.70) Figure 1. ROC curve and AUC of the DN4 questionnaire (total
in neuropathic and non-neuropathic pain groups score $4) in patients with NP.
(Cronbach’s a coefficient values ranged from 0.93 to
1.00 in the neuropathic group and 0.79 to 1.00 in the
non-neuropathic group). The total score of the DN4 ques- respectively, whereas in the non-neuropathic group
tionnaire test and retest reliability was also good, with these scores were 1 for both. The sensitivity and spec-
a high intraclass correlation coefficient between the 2 ificity of the DN4 questionnaire (with a cut-off value
time periods in both neuropathic and non-neuropathic $4 of the total score) in the diagnosis of neuropathic
pain groups (ICC, 0.95 and 0.96, respectively) (Table 4). pain within neuropathic pain patients were found to
be 95% and 96.6%, respectively. The sensitivity of
Validity the LANSS questionnaire (with a cut-off value $12 of
To differentiate NP from NNP, the indicators of validity the total score) within neuropathic pain patients was
tested by construct validity, sensitivity, and specificity of 70.2%, whereas the specificity of the scale was
the DN4 questionnaire were found to be good. Total 96.6% (Table 5). These results indicate a strong rela-
scores of DN4 questionnaire in neuropathic and non- tionship between clinical diagnosis (gold standard)
neuropathic patients were high, which correlated with and DN4 questionnaire scores with accepted cut-off
the total scores in LANSS questionnaire (construct valid- values ($4). The physicians completed the DN4 ques-
ity r = 0.60, P = 0.000 in neuropathic patients and r= tionnaire in 1 minute 6 15 seconds and the LANSS
0.61, p=0.000 in non-neuropathic pain patients). The questionnaire in 3 minutes 6 30 seconds. Compared
DN4 questionnaire validity was also tested by ROC curve with the LANSS questionnaire, the DN4 questionnaire
and AUC analysis. A total score $4 points in the DN4 was noted to be easy to apply by the physicians and
questionnaire was very effective to discriminate be- to get a quick reply from the patients. These results
tween neuropathic and non-neuropathic patients (Fig 1). suggest that the DN4 questionnaire can be adminis-
tered in a very short time without any burden on
patients or physicians.
Comparison of DN4 and LANSS
Questionnaires
In the neuropathic pain group, for the DN4 and the Discussion
LANSS, the sum of median scores were 6.6 and 16, The diagnosis of neuropathic pain is still very challeng-
ing. Clinicians who are not pain specialists have a request
Table 4. Internal Consistency and Test-Retest for a short, simple, but accurate tool to identify the neu-
Reliability of the Turkish Version of the Total ropathic pain patients in their daily practice. Besides,
Score of DN4 Questionnaire in Patients With there is a need of a standardized identification of neuro-
Neuropathic Pain and Non-Neuropathic Pain pathic pain patients in research studies. In this study we
validated the Turkish version of the DN4 questionnaire
INTERNAL
CONSISTENCY to be used in neuropathic pain patients. Our results con-
(CRONBACH’S a) TEST RE-TEST ICC (95% CI) firmed test-retest reliability and internal consistency. We
also reviewed all the current screening tools and com-
NP 0.97 6.64 6 1.87 6.65 6 1.78 0.95 (0.94-0.97)
NNP 0.98 1.11 6 1.26 1.03 6 1.29 0.96 (0.94-0.97)
pared the strengths and weaknesses of the DN4 with
the LANSS questionnaire.
Unal-Cevik, Sarioglu-Ay, and Evcik The Journal of Pain 1133
Table 5. _
Accuracy of the Two Screening Tools in Identifying Patients With Neuropathic Pain
SENSITIVITY SPECIFICITY PPV NPV
DN4 95 (89.6-97.7) 96.6 (88.5-99.1) 98.3 (94.8-99.5) 90.5 (85.0-94.2)
LANSS 70.2 (61.6-77.7) 96.6 (88.5-99.1) 97.7 (93.9-99.2) 61.3 (53.7-68.4)

Abbreviations: PPV, positive predictive value; NPV, negative predictive value.

NOTE. All numbers are presented as percetages within a 95% confidence interval.

Our study population consisted of 180 pain patients. be due to the lesser number of patients and different
Similar to the original report, the etiology of our neuro- clinical characteristics of their study population. In their
pathic pain patients was more common with peripheral neuropathic pain group, the median LANSS score was re-
rather than central origin.6 In our study, neuropathic ported to be 18,28 whereas our neuropathic pain patients
pain associated with radiculopathies and polyneuropa- had a LANSS median score of 16. In contrast to the DN4
thies dominated. A ratio of 10:1 among peripheral ver- questionnaire, which gives 1 score to each item, the
sus central neuropathic pain and a dominance of LANSS questionnaire gives different scores according to
diabetic polyneuropathy and radiculopathy was re- each positive question.3 For example, in the LANSS, the
ported in a European neurologist survey as well.24 second question, related to the change in color of the
Thus, with our study population, we were able to deter- skin (autonomic dysfunction), gives 5 points when it is
mine the neuropathic pain components in more com- present. This feature is most commonly observed in
plex pain conditions of mixed origin. Radiculopathies CRPS patients. In our study, 81.8% of the neuropathic
associated with the neuropathic pain component has pain patients responded ‘‘no,’’ so the total score auto-
been also shown by recent studies.13,14,22 In clinical matically dropped down to 19. The 4th question related
trials with neuropathic pain, a patient’s VAS score of with electric shocks and the 5th question related with
$3 is usually needed as an inclusion criteria,23 and the feeling of hot or burning are weighted very low
our study patients had VAS score >5. The adaptation (scores of 2 and 1, respectively) in the LANSS question-
procedure was followed according to the established naire.3 However, burning pain and electric shocks are
protocols.27 Patients of neuropathic pain or non- very dominant sensory descriptors both in our study pop-
neuropathic pain group did not differ according to ulation and in previously reported neuropathic pain pa-
sex, occupation, or educational level. This enabled us tients.6,8 In the LANSS questionnaire, the presence of
to interpret that there was no difference in level of un- mechanical allodynia is scored in both the 3rd and 6th
derstanding of the questionnaires in both groups. Reli- items. If a patient does not have mechanical allodynia,
ability of the DN4 questionnaire, tested with internal then the total score drops automatically down to 16.
consistency and test-retest, was very good, and our re- We think these may all account for the low sensitivity
sults were also comparable with the Spanish version of of the LANSS questionnaire in detection of neuropathic
the DN4 study.20 The validity of Turkish version of the pain patients, compared with the DN4 questionnaire in
DN4 questionnaire led us to notice its high diagnostic our study. We think, as both questionnaires have the
properties. We applied both DN4 and LANSS question- same specificity, due to the higher sensitivity of DN4
naires to each patient, which enabled us to test and questionnaire, it will be less likely to miss the
compare neuropathic pain terms at the same time in identification of neuropathic pain patients. Many
the same patient. The presence of each 10 items (7 de- clinicians, either non-pain specialist or primary care phy-
scriptive and 3 examination parts) of the DN4 question- sicians, are dealing with chronic pain patients. However,
naire was statistically significant in the neuropathic pain they usually complain of not having adequate skill or
group. The most important features of neuropathic enough time to evaluate these patients. In this study,
pain were tingling, burning, and pins and needles and we documented that the DN4 was an easy and very short
electric shocks, the same as in the original study.6 Itch (1 minute test) compared with the LANSS. The DN4 ques-
as a neuropathic pain symptom was assessed in the tionnaire was found to be very definite (easy to be ap-
DN46 and in the SF-MPQ-2 questionnaires.11 We found plied by the physician) and the LANSS to be very
that 30.6% reported itching in the neuropathic pain descriptive (for the patient).
group, similar to the original report.6 We conclude We conclude that the Turkish version of DN4 question-
that as neuropathic itch may be a very bothersome naire is a reliable, valid, short, and quick screening tool in
problem for the patients seeking treatment, this symp- identification of neuropathic pain patients to be used in
tom must be correctly diagnosed and treated appropri- daily clinical practice and multicenter clinical research
ately as previously reported.5 studies.
The sensitivity of the DN4 questionnaire (total score
$4) was higher than in the LANSS questionnaire (total
score of $12). In a validation study of the Turkish version Acknowledgments
of the LANSS questionnaire, the sensitivity and specificity The authors thank to Dr M. Zulkuf Onal for his contri-
(from 44 neuropathic pain patients and 49 nociceptive bution in Turkish translation of the DN4 questionnaire
pain patients) were found to be 89.9% and 94.2%, re- and Dr Atilla Elhan for statistical assistance. The authors
spectively.28 We may assume that this discrepancy might report no conflicts of interests.
1134 The Journal of Pain DN4 and LANSS Scales in the Assessment of Neuropathic Pain
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Unal-Cevik, Sarioglu-Ay, and Evcik The Journal of Pain 1135

Appendix A: Questionnaire DN4 Appendix B: DN4 Anketi

Please complete this questionnaire by ticking 1 answer Lütfen bu anketi asxağıdaki 4 sorunun her bir maddesi için
for each item in the 4 questions below: bir cevap is
xaretleyerek doldurunuz:

Interview of the Patient Hasta ile Görüsxme

Question 1.Does the pain have one or more of Soru 1. Ağrı, asxağıdaki bir veya daha fazla
the following characteristics? özelliğe sahip mi?
YES NO
EVET HAYIR
1. Burning
2. Painful cold 1. Yanma
3. Electric shocks 2. Ağrılı soğuk hissi
3. Elektrik çarpması

Question 2.Is the pain associated with one or

Soru 2. Ağrı, aynı bölgede as
xağıdaki
more of the following symptoms in the same
area? yakınmalardan bir veya daha fazlası ile ilisxkili
mi ?
YES NO
EVET HAYIR
4. Tingling
5. Pins and Needles 4. Karıncalanma
6. Numbness 5. _Iğnelenme
7. Itching 6. Hissizlik
7. Kas xınma

Examination of the Patient Hastanın muayenesi

Question 3. Is the pain located in an area where Soru 3.Ağrı ; fizik muayenenin yapıldığı bir
the physical examination may reveal one or alana lokalize ve asxağıdaki özelliklerden bir
more of the following characteristics? veya daha fazlasını açığa çıkarıyor mu?
YES NO EVET HAYIR
8. Touch hypoesthesia 8. Dokunma hipoestezisi
9. Pricking hypoesthesia 9. _Iğne hipoestezisi

Question 4.In the painful area, can the pain be Soru 4.Ağrılı bölgede, ağrıya neden olabiliyor
caused or increased by: ya da arttırabiliyor mu:
YES NO EVET HAYIR
10. Brushing 10. Fırçalama

Patient score: /10. Hastanın puanı: /10.