Validation of the Czech language version of the DN4 and PainDetect questionnaire for diagnosing neuropathic pain

Authors: P. Krkoška *;  A. Rajdová *;  J. Bednařík;  L. Ryba;  B. Adamová;  E. Vlčková
Authors‘ workplace: Neuromuskulární centrum ERN, Neurologická klinika LF MU a FN Brno ;  P. K. a A. R. se podíleli na provedení, studie i přípravě manuskriptu stejnou, mírou *
Published in: Cesk Slov Neurol N 2022; 85(1): 59-69
Category: Original Paper
doi: 10.48095/cccsnn202259


Background: Neuropathic pain is a frequent vlinical manifestation of many neurological disorders. Simple questionnaires mainly based on the presence of so called “neuropathic pain descriptors” represent the most important screening tool in the diagnosis of this condition. Aim: The aim of this study was to validate the Czech language version of two most frequently used questionnaires focused on neuropathic pain diagnosis by non-specialists, i.e., Douleur Neuropathique en 4 Questions (DN4cz) and painDetect (PDQcz). Patients and methods: Initially, the language validation of both questionnaires was performed. In the next step, two groups of patients were examined using these Czech language versions of both questionnaires: a group of patients suffering from peripheral neuropathic pain (in diabetic polyneuropathy or polyneuropathies of other etiology) (N = 65), and a group of individuals with nociceptive pain due to severe coxarthrosis or gonarthrosis or chronic low back pain (N = 74). Results: Both questionnaires proved to be easy-to-use and understandable. The patients with neuropathic pain reached significantly higher both partial and overall scores in both questionnaires compared to nociceptive pain patients. ROC analysis confirmed an excellent diagnostic validity of both questionnaires in the discrimination between neuropathic and nociceptive pain. However, the optimal cut-off with the highest possible diagnostic validity for the PDQcz was found significantly lower than had been recommended. Conclusions: The Czech language versions of both DN4 and PDQ questionnaires proved excellent diagnostic validity in the discrimination of neuropathic and nociceptive pain. Both of them thus can be recommended as easy and useful tools for diagnosis of neuropathic pain by non-specialists. To reach optimal diagnostic validity, the cut-off of the PDQ should be set lower than had been previously recommended.


questionnaire – Neuropathic pain – polyneuropathy – nociceptive pain – pain measurement – diabetic neuropathy – osteoarthrosis


1. Finnerup NB, Haroutounian S, Kamerman P et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain 2016; 157 (8): 1599–1606. doi: 10.1097/j.pain.0000000000000492.

2. Oosterling A, te Boveldt N, Verhagen C et al. Neuropathic pain components in patients with cancer: prevalence, treatment, and interference with daily activities. Pain Pract 2016; 16 (4): 413–421. doi: 10.1111/papr.12 291.

3. Torrance N, Smith BH, Bennett MI et al. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain 2006; 7 (4): 281–289. doi: 10.1016/j.jpain.2005.11.008.

4. Bouhassira D, Lantéri-Minet M, Attal N et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008; 136 (3): 380–387. doi: 10.1016/j.pain.2007.08.013.

5. Haanpää M, Attal N, Backonja M et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011; 152 (1): 14–27. doi: 10.1016/j.pain.2010.07.031.

6. Attal N, Bouhassira D, Baron R. Dia­gnosis and assessment of neuropathic pain through questionnaires. Lancet Neurol 2018; 17 (5): 456–466. doi: 10.1016/S1474-4422 (18) 30071-1.

7. Šrotová I, Vlčková-Moravcová E, Straková J et al. Validace české verze Neuropathic Pain Symptom Inventory (NPSIcz). Cesk Slov Neurol N 2015; 78/111 (1): 45–56. doi: 10.14735/amcsnn201545.

8. Bouhassira D, Attal N, Alchaar H 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 (1–2): 29–36. doi: 10.1016/j.pain.2004.12.010.

9. Freynhagen R, Baron R, Gockel U et al. PainDETECT: a new screening questionnaire to detect neuropathic components in patients with back pain. Curr Med Res Opin 2006; 22 (10): 1911–1920. doi: 10.1185/030079906X132488.

10. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 2001; 92: 147–157. doi: 10.1016/s0304-3959 (00) 00482-6.

11. Bennett MI, Attal N, Backonja MM et al. Using screening tools to identify neuropathic pain. Pain 2007; 127 (3): 199–203. doi: 10.1016/j.pain.2006.10.034.

12. Freynhagen R, Baron R, Gockel U et al. painDETECT. [online]. Dostupné z URL: https: // cz.pdf

13. Buršová Š, Vlčková-Moravcová E, Hnojčíková M et al. Validita a prediktivní hodnota skríningových testů u prediabetické a časné diabetické polyneuropatie. Cesk Slov Neurol N 2012; 75/108 (5): 562–572.

14. van Seventer R, Vos C, Giezeman M et al. Validation of the Dutch version of the DN4 dia­gnostic questionnaire for neuropathic pain. Pain Pract 2013; 13 (5): 390–398. doi: 10.1111/papr.12006.

15. Chatila N, Pereira B, Maarrawi J et al. Validation of a New Arabic Version of the Neuropathic Pain Dia­g­nostic Questionnaire (DN4). Pain Pract 2017; 17 (1): 78–87. doi: 10.1111/papr.12419.

16. Matsuki Y, Sukenaga N, Miyagi K et al. Reliability and validity of the Japanese translation of the DN4 Dia­gnostic Questionnaire in patients with neuropathic pain. J Anesth 2018; 32 (3): 403–408. doi: 10.1007/s00540-018-2495-7.

17. Sykioti P, Zis P, Vadalouca A et al. Validation of the Greek Version of the DN4 Dia­gnostic Questionnaire for Neuropathic Pain. Pain Pract 2015; 15 (7): 627–632. doi: 10.1111/papr.12221.

18. Gudala K, Ghai B, Bansal D. Hindi version of short form of douleur neuropathique 4 (S-DN4) questionnaire for assessment of neuropathic pain component: a cross--cultural validation study. Korean J Pain 2017; 30 (3): 197–206. doi: 10.3344/kjp.2017.30.3.197.

19. Santos JG, Brito JO, de Andrade DC et al. Translation to Portuguese and validation of the Douleur Neuropathique 4 questionnaire. J Pain 2010; 11 (5): 484–490. doi: 10.1016/j.jpain.2009.09.014.

20. De Andrés J, Pérez-Cajaraville J, Lopez-Alarcón MD et al. Cultural adaptation and validation of the painDETECT scale into Spanish. Clin J Pain 2012; 28 (3): 243–253. doi: 10.1097/AJP.0b013e31822bb35b.

21. Abu-Shaheen A, Yousef S, Riaz M et al. Testing the validity and reliability of the Arabic version of the painDETECT questionnaire in the assessment of neuropathic pain. PLoS One 2018; 13 (4): e0194358. doi: 10.1371/journal.pone.0194358.

22. Epping R, Verhagen AP, Hoebink EA et al. The dia­gnostic accuracy and test-retest reliability of the Dutch PainDETECT and the DN4 screening tools for neuropathic pain in patients with suspected cervical or lumbar radiculopathy. Musculoskelet Sci Pract 2017; 30: 72–79. doi: 10.1016/j.msksp.2017.05.010.

23. Matsubayashi Y, Takeshita K, Sumitani M et al. Validity and reliability of the Japanese version of the painDETECT questionnaire: a multicenter observational study. PLoS One 2013; 8 (9): e68013. doi: 10.1371/journal.pone.0068013.

24. Migliore A, Gigliucci G, Moretti A et al. Cross cultural adaptation and validation of italian version of the leeds assessment of Neuropathic Symptoms and Signs Scale and Pain DETECT Questionnaire for the distinction between nociceptive and neuropathic pain. Pain Res Manag 2021; 2021: 6623651. doi: 10.1155/2021/ 6623651.

25. Sung JK, Choi J-H, Jeong J et al. Korean Version of the painDETECT Questionnaire: a study for cultural adaptation and validation. Pain Pract 2017; 17 (4): 494–504. doi: 10.1111/papr.12472.

26. England JD, Gronseth GS, Franklin G et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodia­gnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64 (2): 199–207. doi: 10.1212/01.WNL.0000149522.32823.EA.

27. Kellgren JH, Lawrence JS. Radiological Assessment of Osteo-Arthrosis. Ann Rheum Dis 1957; 16 (4): 494–502. doi: 10.1136/ard.16.4.494.

28. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8 (2): 135–160. doi: 10.1177/096228029900800204.

29. Bland JM, Altman DG. Cronbach’s alpha. BMJ 1997; 314 (7080): 572. doi: 10.1136/bmj.314.7080.572.

30. Van Seventer R, Vos C, Meerding W et al. Linguistic validation of the DN4 for use in international studies. Eur J Pain 2010; 14 (1): 58–63. doi: 10.1016/j.ejpain.2009.01.005.

31. Gauffin J, Hankama T, Kautiainen H et al. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study. BMC Neurol 2013; 13: 21. doi: 10.1186/1471-2377-13-21.

32. Hasvik E, Haugen AJ, Gjerstad J et al. Assessing neuropathic pain in patients with low back-related leg pain: Comparing the painDETECT Questionnaire with the 2016 NeuPSIG grading system. Eur J Pain 2018; 22 (6): 1160–1169. doi: 10.1002/ejp.1204.

33. Andrasinova T, Kalikova E, Kopacik R et al. Evaluation of the Neuropathic Component of Chronic Low Back Pain. Clin J Pain 2019; 35 (1): 7–17. doi: 10.1097/AJP.00000 00000000653.

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