Neuropathic Pain in 4 Questions (DN4)

Objective

The Neuropathic Pain in 4 Questions (DN4) is a clinician-administered questionnaire used to assess the likelihood of neuropathic pain (Bouhassira et al., 2005).

Interpretation

A score of 4/10 or higher is associated with the presence of neuropathic pain (Bouhassira et al., 2005; Aho et al., 2020).

Execution

The DN4 consists of 10 items using a dichotomous “yes / no” scale. The first part of the questionnaire—the interview section—consists of 7 self-assessment items on pain descriptors. The second part of the questionnaire—the examination section—consists of 3 items related to the sensory examination (Aho et al., 2020).

A score of 1 is assigned to each positive item and a score of 0 to each negative item. The final score ranges from 0 to 10 (Bouhassira et al., 2005; Aho et al., 2020).

Duration

Less than 10 minutes.

Equipment

A sharp object, such as a pin, for item 9.

Clinical Value

The cutoff score of 4 yields the highest percentage of correctly identified patients (86%), with a sensitivity of 82.9% and a specificity of 89.9% (Bouhassira et al., 2005).

The DN4 is one of the questionnaires recommended by the International Association for the Study of Pain (IASP) whose measurement properties have been best demonstrated, particularly in patients with chronic pain (Spallone et al., 2012; Mathieson et al., 2015; Attal et al., 2011).

However, although this questionnaire can provide an indication of the presence of neuropathic pain, it cannot replace a clinical evaluation (Mathieson et al., 2015).

Acknowledgements

We would like to thank Prof. Didier Bouhassira for allowing us to make the DN4 available on Fullphysio.

Original publication: 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.

Bouhassira, Didier, Nadine Attal, Haiel Alchaar, François Boureau, Bruno Brochet, Jean Bruxelle, Gérard Cunin, Jacques Fermanian, Patrick Ginies, Aurélie Grun-Overdyking, Hélène Jafari-Schluep, Michel Lantéri-Minet, Bernard Laurent, Gérard Mick, Alain Serrie, Dominique Valade, and Eric Vicaut. “Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).” Pain 114, no. 1–2 (2005): 29–36.

Aho, Tommi, Laura Mustonen, Eija Kalso, and Hanna Harno. “Douleur Neuropathique 4 (DN4) stratifies possible and definite neuropathic pain after surgical peripheral nerve lesion.” European Journal of Pain 24, no. 2 (2020): 413–22.

Spallone, V., R. Morganti, C. D’Amato, C. Greco, L. Cacciotti, and G. A. Marfia. “Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy.” Diabetic Medicine 29, no. 5 (2012): 578–85.

Mathieson, Stephanie, Christopher G. Maher, Caroline B. Terwee, Tarcisio Folly de Campos, and Chung-Wei Christine Lin. “Neuropathic pain screening questionnaires have limited measurement properties. A systematic review.” Journal of Clinical Epidemiology 68, no. 8 (2015): 957–66.

Attal, Nadine, Serge Perrot, Jacques Fermanian, and Didier Bouhassira. “The Neuropathic Components of Chronic Low Back Pain: A Prospective Multicenter Study Using the DN4 Questionnaire.” The Journal of Pain 12, no. 10 (2011): 1080–87.