Title |
Avoiding Catch-22: validating the PainDETECT in a population of patients with chronic pain
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Published in |
BMC Neurology, June 2018
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DOI | 10.1186/s12883-018-1094-4 |
Pubmed ID | |
Authors |
Hans Timmerman, André P. Wolff, Ewald M. Bronkhorst, Oliver H. G. Wilder-Smith, Marcel J. Schenkels, Nick T. van Dasselaar, Frank J. P. M. Huygen, Monique A. H. Steegers, Kris C. P. Vissers |
Abstract |
Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system and is a major therapeutic challenge. Several screening tools have been developed to help physicians detect patients with neuropathic pain. These have typically been validated in populations pre-stratified for neuropathic pain, leading to a so called "Catch-22 situation:" "a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule". The validity of screening tools needs to be proven in patients with pain who were not pre-stratified on basis of the target outcome: neuropathic pain or non-neuropathic pain. This study aims to assess the validity of the Dutch PainDETECT (PainDETECT-Dlv) in a large population of patients with chronic pain. A cross-sectional multicentre design was used to assess PainDETECT-Dlv validity. Included where patients with low back pain radiating into the leg(s), patients with neck-shoulder-arm pain and patients with pain due to a suspected peripheral nerve damage. Patients' pain was classified as having a neuropathic pain component (yes/no) by two experienced physicians ("gold standard"). Physician opinion based on the Grading System was a secondary comparison. In total, 291 patients were included. Primary analysis was done on patients where both physicians agreed upon the pain classification (n = 228). Compared to the physician's classification, PainDETECT-Dlv had a sensitivity of 80% and specificity of 55%, versus the Grading System it achieved 74 and 46%. Despite its internal consistency and test-retest reliability the PainDETECT-Dlv is not an effective screening tool for a neuropathic pain component in a population of patients with chronic pain because of its moderate sensitivity and low specificity. Moreover, the indiscriminate use of the PainDETECT-Dlv as a surrogate for clinical assessment should be avoided in daily clinical practice as well as in (clinical-) research. Catch-22 situations in the validation of screening tools can be prevented by not pre-stratifying the patients on basis of the target outcome before inclusion in a validation study for screening instruments. The protocol was registered prospectively in the Dutch National Trial Register: NTR 3030 . |
X Demographics
Geographical breakdown
Country | Count | As % |
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United States | 1 | 17% |
Belgium | 1 | 17% |
Netherlands | 1 | 17% |
Unknown | 3 | 50% |
Demographic breakdown
Type | Count | As % |
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Scientists | 3 | 50% |
Members of the public | 2 | 33% |
Science communicators (journalists, bloggers, editors) | 1 | 17% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 79 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 16 | 20% |
Student > Bachelor | 10 | 13% |
Researcher | 6 | 8% |
Student > Ph. D. Student | 6 | 8% |
Student > Doctoral Student | 5 | 6% |
Other | 14 | 18% |
Unknown | 22 | 28% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 20 | 25% |
Nursing and Health Professions | 20 | 25% |
Psychology | 3 | 4% |
Arts and Humanities | 2 | 3% |
Sports and Recreations | 2 | 3% |
Other | 6 | 8% |
Unknown | 26 | 33% |