Development and validation of Arabic version of the douleur neuropathique 4 questionnaire

Abdullah Sulieman Terkawi, Abdullah Abolkhair, Bouhassira Didier, Tariq Alzhahrani, Mazen Alsohaibani, Yazzed Sulieman Terkawi, Yousuf Almoqbali, Yasser Younis Tolba, Evelyn Pangililan, Farida Foula, Siny Tsang, Abdullah Sulieman Terkawi, Abdullah Abolkhair, Bouhassira Didier, Tariq Alzhahrani, Mazen Alsohaibani, Yazzed Sulieman Terkawi, Yousuf Almoqbali, Yasser Younis Tolba, Evelyn Pangililan, Farida Foula, Siny Tsang

Abstract

Introduction: The douleur neuropathique 4 (DN4) questionnaire is a widely used tool for diagnosis of neuropathic pain (NP). The aim was to translate, culturally adapt, and validate the DN4 questionnaire in Arabic.

Methods: A systematic translation process was used to translate the original English DN4 into Arabic. After the pilot study, the Arabic version was validated among patients with chronic pain in two tertiary care centers. The reliability of the translated version was examined using internal consistency, test-retest reliability, and intraclass correlation coefficients. We examined the validity of the Arabic DN4 via construct validity, concurrent validity (associations with the numeric rating scale, brief pain inventory, and Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), face validity, and diagnostic validity. To investigate the responsiveness, the translated DN4 was administered twice among the same group of patients.

Results: A total of 142 subjects (68 men, 74 women) were included in the study. Cronbach's α was 0.67 (95% confidence interval [CI]: 0.59-0.75), and interclass correlation coefficients was 0.81 (95% CI: 0.76-0.87). The DN4 was moderately associated with the S-LANSS questionnaire. Results showed our Arabic DN4 to have good diagnostic accuracy, with area under the curve of 0.88 (95% CI: 0.82-0.94). As with the original version, a score of ≥4 was found to be the best cut-off for the diagnosis of NP, with a sensitivity of 88.31%, specificity of 74.47%, a positive predictive value of 85%, and a negative predictive value of 80%. Most patients found the DN4 questionnaire to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain.

Conclusion: Our Arabic version of the DN4 is a reliable and valid screening tool that can be easily administered among patients to differentiate between NP and non-NP.

Keywords: Anesthesia; Arabic; douleur neuropathique 4; neuropathic pain; reliability; validity.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Cut-off point in the douleur neuropathique 4 optimizing the sensitivity and specificity to distinguish between patients with and without neuropathic pain in the current study

References

    1. GBD DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1603–58.
    1. Moradi-Lakeh MH, El Bcheraoui C, Daoud F, Afshin A, Charara R, Khalil I, et al. Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013. Ann Rheum Dis. 2017. Available from: .
    1. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630–5.
    1. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4) Pain. 2005;114:29–36.
    1. Cruccu G, Sommer C, Anand P, Attal N, Baron R, Garcia-Larrea L, et al. EFNS guidelines on neuropathic pain assessment: Revised 2009. Eur J Neurol. 2010;17:1010–8.
    1. Van Seventer R, Vos C, Meerding W, Mear I, Le Gal M, Bouhassira D, et al. Linguistic validation of the DN4 for use in international studies. Eur J Pain. 2010;14:58–63.
    1. Harifi G, Ouilki I, El Bouchti I, Ouazar MA, Belkhou A, Younsi R, et al. Validity and reliability of the Arabic adapted version of the DN4 questionnaire (Douleur Neuropathique 4 questions) for differential diagnosis of pain syndromes with a neuropathic or somatic component. Pain Pract. 2011;11:139–47.
    1. Terkawi AS, Backonja MM, Abolkhair A, Al-Zhahrani T, Almaharbi S, Joy J, et al. Development and validation of Arabic version of the neuropathic pain questionnaire-short form (NPQ-SF) Saudi J Anesth. 2017;11(Suppl 1):S53–62.
    1. Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. Handbook of Pain Assessment. New York: The Guilford Press; 2001. pp. 15–34.
    1. Cleeland CS, Ryan KM. Pain assessment: Global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129–38.
    1. Brief Pain Inventory – Arabic Version. [Last accessed on 2017 Jan 07]. Available from: .
    1. Bennett M. The LANSS Pain Scale: The leeds assessment of neuropathic symptoms and signs. Pain. 2001;92:147–57.
    1. Elzahaf RA, Tashani OA, Unsworth BA, Johnson MI. Translation and linguistic validation of the self-completed leeds assessment of neuropathic symptoms and signs (S-LANSS) scale for use in a Libyan population. Pain Pract. 2013;13:198–205.
    1. Nunnally J. Psychometric Theory. New York: McGraw-Hill; 1978.
    1. Nunnally JC, Bernstein IH. Psychometric Theory. 3rd ed. New York: McGraw-Hill; 1994.
    1. Altman DG. Practical Statistics for Medical Research. Washington: Chapman & Hall; 1999.
    1. Taube A. Sensitivity, specificity and predictive values: A graphical approach. Stat Med. 1986;5:585–91.
    1. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.
    1. Terkawi AS, Tsang S, Abolkhair A, Alsharif M, Alswiti M, Alsadoun A, et al. Development and validation of the Arabic version of the short-form of McGill pain questionnaire. Saudi J Anesth. 2017;11(Suppl 1):S2–10.
    1. Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. Clin J Pain. 2003;19:306–14.
    1. Sykioti P, Zis P, Vadalouca A, Siafaka I, Argyra E, Bouhassira D, et al. Validation of the Greek version of the DN4 diagnostic questionnaire for neuropathic pain. Pain Pract. 2015;15:627–32.
    1. Santos JG, Brito JO, de Andrade DC, Kaziyama VM, Ferreira KA, Souza I, et al. Translation to Portuguese and validation of the Douleur Neuropathique 4 questionnaire. J Pain. 2010;11:484–90.
    1. Perez C, Galvez R, Huelbes S, Insausti J, Bouhassira D, Diaz S, et al. Validity and reliability of the Spanish version of the DN4 (Douleur Neuropathique 4 questions) questionnaire for differential diagnosis of pain syndromes associated to a neuropathic or somatic component. Health Qual Life Outcomes. 2007;5:66.
    1. Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, et al. Using screening tools to identify neuropathic pain. Pain. 2007;127:199–203.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa