The Clinical Journal of Pain 19:315316 2003 Lippincott Williams & Wilkins, Inc.

, Philadelphia

Short Report

Neuropathic Pain QuestionnaireShort Form

*Misha-Miroslav Backonja, MD and Steven J. Krause, PhD
*Department of Neurology, and Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin, Madison, Wisconsin

Neuropathic pain is a frequent clinical challenge, particularly given the difficulties frequently encountered in diagnosis. As a result, development of a clinical tool that can discriminate it from non-neuropathic pain is an important step in assessment and treatment planning for patients with these chronic pain disorders. A study addressing the ability of patients pain descriptors to differentiate neuropathic from non-neuropathic pain has been conducted and yielded a Neuropathic Pain Questionnaire (NPQ). This measure consists of a relatively comprehensive groups of twelve descriptors that characterize symptoms of neuropathic pain. In the initial development of the NPQ, a discriminant analysis was performed on all 12 predictor items simultaneously, to determine the degree to which these items could collectively predict neuropathic versus nonneuropathic pain. In the current analysis, we sought to determine the minimum number of items sufficient to predict diagnostic group membership, without statistically significant loss of predictive accuracy. METHODS Subjects The subjects from this study were those previously reported in the initial development of the Neuropathic Pain Questionnaire.1 The initial group consisted of 528 patients from several clinics at the University of Wisconsin Hospital and Clinics, and the Madison (Wisconsin) Veterans Administration Hospital. Subjects were categorized into diagnostic groups by chart review, and the inter-rater reliability of those diagnostic judgments assessed. Only those subjects who had exclusively neuropathic pain (N 110), exclusively non-neuropathic pain (N 168), and who had complete sets of data on all 12 NPQ items were retained for this analysis. Statistics The 12 NPQ items were subjected to a stepwise discriminant analysis. This procedure adds items sequentially rather than simultaneously, and ceases to add items

TABLE 1. Canonical discriminant function coefficients and structure coefficients

Item 8. Numbness 14. Tingling pain 29. Increased pain due to touch constant Canonical discriminant Structure function coefficient coefficient 0.017 0.015 0.011 1.302 0.819 0.828 0.569

when doing so would not yield a statistically significant increase in predictive accuracy. RESULTS The stepwise discriminant analysis identified three items from the NPQ as significant predictors (Wilks 0.732; P < 0.001). These were Tingling Pain, Numbness, and Increased Pain due to Touch. The canonical discriminant function coefficients and structure coefficients for these variables are listed in Table 1. The resulting canonical discriminant function was able to predict neuropathic pain with a sensitivity of 64.5%, specificity of 78.6%, and total predictive accuracy of 73.0%. This represents a slight decrease in accuracy from the original NPQ sample, which demonstrated 76.4% accuracy, with 71.4% accuracy in the holdout sample. CONCLUSION From a practical clinical prospective it was encouraging that this additional analysis yielded a small number of items that preserved the ability to differentiate neuropathic from non-neuropathic pain. The selection of these particular items is consistent with basic premise that neuropathic pain is diagnoses through the use of positive sensory phenomenon such as increased pain due to touch, negative sensory phenomenon such as numbness, and phenomena suggestive of paresthesiae and dysesthesiae such as tingling pain. It is the authors hope that this relatively simple and straight forward outcome will encourage clinicians as well as researchers to use the power of clinical symptoms and signs for the purposes of clinical diagnosis and research. REFERENCE
1. Krause SJ, Backonja MM. Development of a europathic pain questionnaire. Clin J Pain. 2003;19:306314.

Received July 5, 2002; accepted July 5, 2002. Correspondence and reprints: Misha-Miroslav Backonja, MD, Department of Neurology, University of Wisconsin, 600 Highland Ave., H61550, Madison, WI 53792. E-mail: backonja@neurology.wisc.edu.

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Krause and Backonja NEUROPATHIC PAIN QUESTIONNAIREShort Form

In order to assess and treat your pain problem, we need to thoroughly understand just exactly what type of pain you have, and how it may or may not change over time. You may have only one site of pain, or you may have more than one. Please name the site of pain which is most severe or disturbing for you (eg, arm, foot, etc): For all of the following questions, please rate your pain at the site you just listed. Please use the space below to describe your pain in your own words as well: Please use the items below to rate your pain as it usually feels. Indicate a number which represents your pain on each scale. For example, if you have no tingling pain, you would rate the first item 0. If you have the worst tingling pain imaginable, you would rate it 100. If neither of those fits your pain because it is in between, choose a number which fits your pain. 1Sf. Tingling Pain 0 No Tingling Pain 2Sf. Numbness 0 No Numbness Sensation

100 Worst Tingling Pain Imaginable

Please rate your usual pain:

100 Worst Numbness Imaginable

Please rate your usual pain:

We are also interested in learning what circumstances cause changes in your pain. Please write the number that indicates the amount you experience each of the following: 3Sf. Increased pain due to touch 0 No Increase At All

100 Greatest Increase Imaginable

Please rate your usual pain:

Canonical Discriminant Function Coefficients and Structure Coefficients Item 1Sf. Numbness 2Sf. Tingling Pain 3Sf. Increased Pain due to Touch Constant Canonical Discriminant Function Coefficient .017 .015 .011 Structure Coefficient .819 .828 .569 1.302

TOTAL DISCRIMINANT FUNCTION SCORE: Check one of the following boxes: Discriminant Function Score Below 0: Discriminant Function Score at or Above 0:
The Clinical Journal of Pain, Vol. 19, No. 5, 2003

Predicts Non-Neuropathic Pain Predicts Neuropathic Pain