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Pain. 2019 May 16. doi: 10.1097/j.pain.0000000000001601. [Epub ahead of print]

Can self-reported pain characteristics and bedside test be used for the assessment of pain mechanisms? An analysis of results of neuropathic pain questionnaires and quantitative sensory testing.

Author information

1
Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany.
2
Institut of Medical Informatics and Statistics, University of Kiel, University Hospital of Schleswig-Holstein, Campus Kiel, Germany.
3
Department of Neurology, General Hospital Fürth, Jakob-Henle-Straße 1, 90766 Fürth, Germany.
4
Department of Pain Management, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Germany.
5
Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Germany.
6
Department of Anesthesiology, University Hospital Munich, Campus Großhadern, Munich.
7
Department of Neurology, University of Würzburg, Germany.
8
Department of Neurology, University Medical Centre Mainz, Mainz, Germany.
9
Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
10
Chair of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Germany.

Abstract

Hyperalgesia and allodynia are frequent in neuropathic pain. Some pain questionnaires like the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and the Neuropathic Pain Scale (NPS) include self-assessment or bedside-testing of hyperalgesia/allodynia. The aim of this study was to determine to what extent LANSS and NPS data are congruent with findings upon quantitative Sensory Testing (QST).Self-reported presence of dynamic mechanical allodynia (DMA) and descriptors of hot, cold or deep ongoing pain (NPS, LANSS) as well as bedside findings of mechanical allodynia (LANSS) were compared to signs of DMA and thermal hyperalgesia upon QST in 617 neuropathic pain patients.Self-reported abnormal skin sensitivity (LANSS) showed a moderate concordance with DMA during bedside test (67.9%, k=0.391) or QST (52.8%, k=0.165). Receiver operating curve analysis for self-reported DMA yielded similar area-under-the-curve values for LANSS (0.65, CI: 0.59-0.97%) and NPS (0.71, CI: 0.66-0.75%) with high sensitivity but low specificity. Self-reported deep pain intensity was higher in patients with blunt pressure hyperalgesia, but not in patients with DMA or thermal hyperalgesia. No correlations were observed between self-reported hot or cold pain quality and thermal hyperalgesia upon QST.Self-reported abnormal skin sensitivity has a high sensitivity to identify patients with DMA, but its low specificity indicates that many patients mean something other than DMA when reporting this symptom. Self-reported deep pain is related to deep-tissue hypersensitivity, but thermal qualities of ongoing pain are not related to thermal hyperalgesia. Questionnaires mostly evaluate the ongoing pain experience while QST mirrors sensory functions. Therefore, both methods are complementary for pain assessment.

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