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A Review on Autophagy in Orofacial Neuropathic Pain. Cells 2022; 11:cells11233842. [PMID: 36497100 PMCID: PMC9735968 DOI: 10.3390/cells11233842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Orofacial neuropathic pain indicates pain caused by a lesion or diseases of the somatosensory nervous system. It is challenging for the clinician to diagnose and manage orofacial neuropathic pain conditions due to the considerable variability between individual clinical presentations and a lack of understanding of the mechanisms underlying the etiology and pathogenesis. In the last few decades, researchers have developed diagnostic criteria, questionnaires, and clinical assessment methods for the diagnosis of orofacial neuropathic pain. Recently, researchers have observed the role of autophagy in neuronal dysfunction as well as in the modulation of neuropathic pain. On this basis, in the present review, we highlight the characteristics, classification, and clinical assessment of orofacial neuropathic pain. Additionally, we introduce autophagy and its potential role in the modulation of orofacial neuropathic pain, along with a brief overview of the pathogenesis, which in future may reveal new possible targets for treating this condition.
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2
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Melsom Myhre A, Strand LI. Reliability of the Norwegian version of PainDETECT: a test-retest study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.2001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anette Melsom Myhre
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Conti PCR, Bonjardim LR, Stuginski-Barbosa J, Costa YM, Svensson P. Pain complications of oral implants: Is that an issue? J Oral Rehabil 2020; 48:195-206. [PMID: 33047362 DOI: 10.1111/joor.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 01/03/2023]
Abstract
The use of oral implants as a form of replacing missing teeth in partial or total edentulous patients is considered the gold standard in oral rehabilitation. Although considered a history of success in contemporary dentistry, surgical complications may occur, as excessive bleeding, damage to the adjacent teeth and mandibular fractures. Persistent pain and abnormal somatosensory responses after the surgery ordinary healing time are also potential problems and may lead to the development of a condition named posttraumatic trigeminal neuropathic pain (PTNP). Though relatively rare, PTNP has a profound impact on patient's quality of life. Appropriated previous image techniques, effective anaesthetic procedures and caution during the surgical procedure and implant installation are recommended for the prevention of this condition. In case of the PTNP, different management modalities, including antidepressant and membrane stabilizer medications, as well as peripheral strategies, as the use of topical medication and the botulin toxin are presented and discussed.
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Affiliation(s)
- Paulo César Rodrigues Conti
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Brazil.,Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil
| | - Leonardo Rigoldi Bonjardim
- Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.,Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Yuri Martins Costa
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmø University, Malmø, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON)
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4
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Tampin B, Royle J, Bharat C, Trevenen M, Olsen L, Goucke R. Psychological factors can cause false pain classification on painDETECT. Scand J Pain 2020; 19:501-512. [PMID: 30901319 DOI: 10.1515/sjpain-2018-0355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/15/2019] [Indexed: 01/04/2023]
Abstract
Background and aims The painDETECT questionnaire (PD-Q) has been widely used as a screening tool for the identification of neuropathic pain (NeP) as well as a tool for the characterization of patients' pain profile. In contrast to other NeP screening tools, the PD-Q is the only screening tool with weighted sensory descriptors. It is possible that responses to the PD-Q sensory descriptors are influenced by psychological factors, such as catastrophizing or anxiety, which potentially might contribute to an overall higher score of PD-Q and a false positive identification of NeP. This study aimed to explore (i) the relationship between psychological factors (catastrophizing, anxiety, depression and stress) and the total PD-Q score and (ii) if psychological factors are associated with false positive identifications of NeP on the PD-Q compared to clinically diagnosed NeP. Methods The study was a retrospective review of 1,101 patients attending an outpatient pain centre. Patients were asked to complete the PD-Q, the Pain Catastrophizing Scale (PCS), the Depression, Anxiety and Stress Scale (DASS) and the Brief Pain Inventory (BPI). For patients who were identified by PD-Q as having NeP, their medical records were reviewed to establish if they had a clinical diagnosis of NeP. Results Accounting for missing data, complete datasets of 652 patients (mean age 51 (SD14) years, range 18-88; 57% females) were available for analysis. Based on PD-Q scoring, NeP was likely present in 285 (44%) patients. Depression, anxiety, stress, catastrophizing, BPI pain and BPI interference were all significantly related to each other (p < 0.0001) and patients displaying these traits were significantly more likely to have a positive PD-Q score (p < 0.0001). For patients classified by PD-Q as having NeP, only 50% of patients had a clinical diagnosis of NeP. Anxiety was significantly associated with a false positive classification of NeP on PD-Q (p = 0.0036). Conclusions Our retrospective study showed that psychological factors including catastrophizing, depression, anxiety, and stress were all influential in producing a higher score on the PD-Q. We observed a high rate of false positive NeP classification which was associated with the presence of anxiety. Implications Clinicians and researchers should be aware that a patient's psychological state may influence the responses to PD-Q and consequently the final PD-Q score and its NeP classification.
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Affiliation(s)
- Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Faculty of Business Management and Social Sciences, Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| | - Jane Royle
- Department of Pain Management, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Chrianna Bharat
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Trevenen
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia
| | - Lisa Olsen
- Department of Pain Management, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Roger Goucke
- Department of Pain Management, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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5
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Assessment of Somatosensory and Psychosocial Function of Patients With Trigeminal Nerve Damage. Clin J Pain 2020; 36:321-335. [DOI: 10.1097/ajp.0000000000000806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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6
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Kudel I, Hopps M, Cappelleri JC, Sadosky A, King-Concialdi K, Liebert R, Parsons B, Hlavacek P, Alexander AH, DiBonaventura MD, Markman JD, Farrar JT, Stacey BR. Characteristics of patients with neuropathic pain syndromes screened by the painDETECT questionnaire and diagnosed by physician exam. J Pain Res 2019; 12:255-268. [PMID: 30662281 PMCID: PMC6327912 DOI: 10.2147/jpr.s160513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study was to identify the clinical characteristics, treatment usage, and health outcomes of US adults diagnosed with neuropathic pain (NeP) by experienced physicians. Methods Adults with scores exceeding the threshold for probable NeP (painDETECT ≥19) and diagnosed with NeP by a qualified physician completed a questionnaire that included comorbid conditions, pain symptoms and experiences, medication use, health status (3-level EuroQol 5 Dimensions (EQ-5D-3L]: health utilities index and visual analog scale), pain severity and interference with functioning (Brief Pain Inventory), and work and activity impairment (Work Productivity and Activity Impairment questionnaire). Descriptive analyses were performed for each NeP subtype. Results Participants (n=295) were predominantly female (64.4%), middle-aged (53.9%), and white (51.5%). Chronic low back pain was the most frequently diagnosed major NeP syndrome (n=166), followed by diabetic peripheral neuropathy (n=58), post-trauma neuropathy (n=47), post-surgical neuropathy (n=28), and central NeP (n=23). An additional 45 participants were diagnosed, but did not meet the criteria for the aforementioned subtypes. Participants could be diagnosed with multiple subtypes. Across each NeP subtype, patients reported high rates of comorbid disease, including arthritis (range: 39.1%–64.3%) and high blood pressure (range: 26.1%–69.0%), as well as symptomology that included numbness (range: 68.1%–91.4%) and changes in muscular strength (range: 24.1%–65.2%). The majority of patients reported back pain (range: 77.8%–95.7%) and arthritis/joint pain (range: 68.1%–78.6%). The most commonly reported types of NeP pain medication were non-steroidal anti-inflammatory drugs (range: 43.1%–70.2%), weak opioids (range: 22.2%–39.3%), and strong opioids (range: 8.7%–28.6%). All six NeP groups generally reported similar levels of dysfunction on all self-report measures. The most notable finding was that the EuroQol-5D-3L health utilities index scores for each of the six groups were lower than the US norms by a clinically important amount. Conclusion These exploratory findings indicate that patients with NeP across different etiologies are medically complex and experience impaired function across multiple domains.
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Affiliation(s)
- Ian Kudel
- Health Outcomes Practice, Kantar Health, New York, NY, USA,
| | | | | | | | | | - Ryan Liebert
- Health Outcomes Practice, Kantar Health, New York, NY, USA,
| | | | | | | | | | - John D Markman
- University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - John T Farrar
- Department of Biostatistics and Epidemiology University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Brett R Stacey
- UW Center for Pain Relief, University of Washington, Seattle, WA, USA
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7
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Tisné-Versailles S, Fénélon M, Marteau JM, Catros S, Fricain JC. Injection of ropivacaine combined with pregabalin in a patient with post-traumatic trigeminal neuropathic pain. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2018018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Post-traumatic painful trigeminal neuropathy is a chronic facial pain secondary to trigeminal nerve injury. The treatment of this pain is a therapeutic issue due to the alteration of quality of life that it generates. Observation: A 58-year-old man whose main history of facial trauma has been consulted in the Odontology Department for bilateral trigeminal neuropathic pain that has been evolving for several months. The interrogation revealed continuous pain like electric shocks in the canine areas and daily painful exacerbations. Hyperesthesia and allodynia were found on clinical examination. The patient had received several treatments, oral and local, without significant improvement. As a last resort, injections of ropivacaine every 2 weeks associated with pregabalin (200 mg/day) were performed. At 6 months, there was a clear decrease in the burning sensation and a complete disappearance of painful exacerbations. Discussion: Two studies have recently shown the benefit of the combination of an antiepileptic and a local analgesic in the treatment of classical trigeminal neuralgia, justifying their use in a context of post-traumatic neuropathic pain. Conclusion: Further studies with higher levels of evidence are needed to confirm these preliminary results.
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8
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Jafree DJ, Zakrzewska JM, Bhatia S, Venda Nova C. Accuracy of the painDETECT screening questionnaire for detection of neuropathic components in hospital-based patients with orofacial pain: a prospective cohort study. J Headache Pain 2018; 19:103. [PMID: 30400770 PMCID: PMC6755558 DOI: 10.1186/s10194-018-0932-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/16/2018] [Indexed: 01/03/2023] Open
Abstract
Background Better tools are required for the earlier identification and management of orofacial pain with different aetiologies. The painDETECT questionnaire is a patient-completed screening tool with utility for identification of neuropathic pain in a range of contexts. 254 patients, referred from primary care for management of orofacial pain and attending a secondary care centre, were prospectively recruited, and completed the painDETECT prior to consultation. The aim of this study was to determine the accuracy of the painDETECT to detect neuropathic components of orofacial pain, when compared to a reference standard of clinical diagnosis by experienced physicians, in a cohort of hospital-based patients. Results For the 251 patients included in the analysis, the painDETECT had a modest ability to detect neuropathic components of orofacial pain (AUROC, 0.63; 95% CI, 0.58–0.70; p = 0.001). Patients with orofacial pain diagnoses associated with neuropathic components had higher painDETECT scores than those with non-neuropathic components. However, the painDETECT was weaker at distinguishing patients with mixed pain types, and multiple diagnoses were associated with poor accuracy of the painDETECT. Conclusion In secondary care settings, the painDETECT performed modestly at identifying neuropathic components, and underestimates the complexity of orofacial pain in its mixed presentations and with multiple diagnoses. Prior to clinical applications or research use, the painDETECT and other generic screening tools must be adapted and revalidated for orofacial pain patients, and separately in primary care, where orofacial pain is considerably less common. Electronic supplementary material The online version of this article (10.1186/s10194-018-0932-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniyal J Jafree
- Faculty of Medical Sciences, University College London, London, UK.
| | | | - Saumya Bhatia
- Eastman Dental Institute, UCLH NHS Foundation Trust, London, UK
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9
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Durham J, Stone SJ, Robinson LJ, Ohrbach R, Nixdorf DR. Development and preliminary evaluation of a new screening instrument for atypical odontalgia and persistent dentoalveolar pain disorder. Int Endod J 2018; 52:279-287. [PMID: 30229950 DOI: 10.1111/iej.13017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/13/2018] [Indexed: 01/03/2023]
Abstract
AIM To develop and preliminarily evaluate a new screening instrument for atypical odontalgia (AO) or persistent dentoalveolar pain disorder (PDAP). To evaluate the instrument's performance in detecting AO/PDAP amongst a heterogeneous group of orofacial pain conditions and pain-free controls and empirically compare its performance with an established neuropathic screening instrument (S-LANSS), which is the best available standard. METHODS The study design was cross-sectional; subjects recruited included a convenience sample of pain-free controls (n = 21) and four groups of orofacial pain conditions: AO/PDAP (n = 22); trigeminal neuralgia (n = 21); temporomandibular disorder (n = 41); and acute dental pain (n = 41). The instrument's internal reliability and factor structure were examined alongside its sensitivity and specificity and ROC-determined threshold score. RESULTS The 9 AO/PDAP-specific items were found to moderately correlate with the S-LANSS (r = 0.58; P < 0.01). The 14-items of the full instrument were examined using exploratory factor analysis and reduced to ten items in a two-factor structure that explained 96% of the variance. This 10-item final instrument had a ROC area of 0.77 (95% CI: 0.67; 0.88), sensitivity of 77% (95% CI: 55; 92%), and specificity of 69% (95% CI: 60; 77%) with an intentionally higher false-positive rate than false-negative rate. In contrast, the S-LANSS exhibited sensitivity of 32% (95% CI: 14;55%) and specificity of 78% (95% CI: 70;85%) with less optimal false-positive versus false-negative rates. CONCLUSION This preliminary study confirms the new screening instrument for AO/PDAP merits progression to field testing.
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Affiliation(s)
- J Durham
- Centre for Oral Health Research, School of Dental Sciences, Newcastle upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Dental Hospital, Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S J Stone
- Centre for Oral Health Research, School of Dental Sciences, Newcastle upon Tyne, UK.,Dental Hospital, Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust, Newcastle upon Tyne, UK
| | - L J Robinson
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - R Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, USA
| | - D R Nixdorf
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA.,HealthPartners Institute for Education and Research, Bloomington, MN, USA
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10
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Welte-Jzyk C, Pfau DB, Hartmann A, Daubländer M. Somatosensory profiles of patients with chronic myogenic temporomandibular disorders in relation to their painDETECT score. BMC Oral Health 2018; 18:138. [PMID: 30092795 PMCID: PMC6085668 DOI: 10.1186/s12903-018-0601-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize patients with chronic temporomandibular disorders (TMD) in terms of existing hyperalgesia against cold, heat and pressure. METHODS The extent of hyperalgesia for pressure and thermal sensation in TMD patients was determined by the use of the painDETECT questionnaire ("Is cold or heat in this area occasionally painful?" "Does slight pressure in this area, e.g., with a finger, trigger pain?") and experimental somatosensory testing against thermal and pressure stimuli (Quantitative Sensory Testing; QST). In addition, we explored psychological comorbidity among the chronic TMD patients (hospital anxiety and depression scale, HADS-D and coping strategies questionnaire, CSQ). RESULTS Nineteen patients with chronic TMD and 38 healthy subjects participated in the study. N = 12 patients had a painDETECT score ≤ 12, n = 3 patients had a painDETECT score of 13-18 and n = 4 patients had a painDETECT score ≥ 19. TMD patients with painDETECT scores ≥19 had moderately, strong or very strong enhancement of thermal and pressure pain perception, whereas patients with painDETECT scores 13-18 and ≤ 12 responded these questions with "never", "hardly noticed" or "slightly painful" (p < 0.05-0.01). With increasing painDETECT scores we found increased hyperalgesia for pressure (p < 0.01) and thermal stimuli (p < 0.05) in QST. The patients with a painDETECT score ≥ 19 showed increased signs of anxiety (p < 0.05), depression (p < 0.01), praying and hoping (p < 0.05). CONCLUSION The present study has shown that the PainDETECT questionnaire can be a helpful additional diagnostic tool. Together with QST, the PainDETECT questionnaire detected hyperalgesia for pressure and thermal sensation. Therefore the PainDETECT questionnaire is helpful to decide which TMD patients should undergo QST.
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Affiliation(s)
- C Welte-Jzyk
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - D B Pfau
- Mannheim Institute of Public Health (MIPH), Social and Preventive Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim (CBTM), University of Heidelberg, Heidelberg, Germany
| | - A Hartmann
- Private Practice Dr. Seiler and colleagues, Filderstadt, Germany
| | - M Daubländer
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
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11
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Melotti R, Ruscheweyh R, Pramstaller PP, Hicks AA, Pattaro C. Structural Consistency of the Pain Sensitivity Questionnaire in the Cooperative Health Research In South Tyrol (CHRIS) Population-Based Study. THE JOURNAL OF PAIN 2018; 19:1424-1434. [PMID: 30017960 DOI: 10.1016/j.jpain.2018.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
The self-reported Pain Sensitivity Questionnaire (PSQ) is a valid supplement to experimental pain testing. However, the latent constructs determining the originally proposed 1 general score (PSQ-total) and 2 subscores (PSQ-moderate and PSQ-minor) have not been consistently investigated in population-based studies or between genders. Based on a single construct hypothesized by expert knowledge or alternative constructs upon empirical evidence, PSQ structures were explored and confirmed among 4,820 participants aged 18 to 93 years of the Cooperative Health Research In South Tyrol (CHRIS) study. By exploratory factor analysis, we identified 3 alternative sets of PSQ imagined painful situations comprising 14, 10, and 9 items, which displayed simple structures of the rotated factor loadings of direct interpretation. In confirmatory analysis (CFA) of 1 latent factor, the 10-item set yielded acceptable goodness-of-fit overall, better fit than the alternative sets and consistent structural properties between genders. Separate analyses based on 14- and 9-item sets returned considerable correlations between 2 latent constructs. In higher-order CFA with each set, 1 first-order general factor explained a large part of the variances of 2 second-order factors. One dominant construct consistently describes the factorial structure of the PSQ. Averaging across the 10-item set, the PSQ-short score represents a structurally robust, gender-consistent, and practical measure of general pain sensitivity. PERSPECTIVE: One dominant latent construct of general pain sensitivity consistently determines responses to the self-reported PSQ. The PSQ-short score maintains similar psychometric properties to the PSQ-total and between genders. This measure is attractive for large-scale research and clinical screening of pain sensitivity.
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Affiliation(s)
- Roberto Melotti
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy.
| | - Ruth Ruscheweyh
- Department of Neurology, University of Munich, München, Germany
| | - Peter P Pramstaller
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy; Department of Neurology, General Central Hospital, Bolzano, Italy; Department of Neurology, University of Lubeck, Lübeck, Germany
| | - Andrew A Hicks
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Cristian Pattaro
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
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12
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Lopez-Jornet P, Molino-Pagan D, Parra-Perez P, Valenzuela S. Neuropathic Pain in Patients with Burning Mouth Syndrome Evaluated Using painDETECT. PAIN MEDICINE 2018; 18:1528-1533. [PMID: 28057813 DOI: 10.1093/pm/pnw304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective This study set out to identify the neuropathic component of pain experienced by burning mouth syndrome (BMS) patients evaluated using painDETECT, a diagnostic tool that could easily be introduced into clinical practice. Materials and Methods This study included 64 patients (33 BMS and 31 suffering nociceptive pain). Each completed the painDETECT neuropathic pain questionnaire, the Hospital Anxiety and Depression Scale, and pain intensity was also measured using a visual analogue scale (VAS). Results Pain among BMS patients (evaluated by VAS) was 6.1 ± 1.9, and 4.3 ± 1.7 among nociceptive patients ( P < 0.001). PainDETECT obtained total scores ≥ 19 in 21% of BMS patients, indicating the presence of neuropathic pain. When painDETECT pain descriptors were analyzed comparing the BMS group with nociceptive pain subjects, statistically significant differences were found for burning sensation ( P < 0.010), prickling ( P < 0.001), electric shock-like sensation ( P = 0.046), thermal sensation ( P < 0.001), and numbness ( P = 0.002). Logistic regression analysis found that VAS scoring was the strongest determinant predicting neuropathic pain. Conclusion The present study suggests that almost a third of BMS patients present neuropathic pain, which is strongly associated with the intensity of pain measured using VAS. These data could provide the basis for further research.
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Affiliation(s)
- Pia Lopez-Jornet
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca-UMU), Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | | - Sara Valenzuela
- Faculty of Medicine and Dentistry, University of Murcia, Murica, Spain
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13
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Hiraoka Y, Akashi M, Wanifuchi S, Kusumoto J, Shigeoka M, Hasegawa T, Hashikawa K, Terashi H, Komori T. Association between pain severity and clinicohistopathologic findings in the mandibular canal and inferior alveolar nerve of patients with advanced mandibular osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:264-271. [PMID: 29776771 DOI: 10.1016/j.oooo.2018.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/06/2018] [Accepted: 03/16/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Pain is one of the most problematic symptoms in patients with osteoradionecrosis of the jaws. This study investigated the associations between pain severity and morphologic alterations of the mandibular canal and inferior alveolar nerve, in respective computerized tomography images and resected specimens of mandibular osteoradionecrosis. STUDY DESIGN We assessed 14 lesions in 13 patients who underwent segmental mandibulectomy for surgical debridement and simultaneous reconstruction with free fibula flap (1 patient exhibited bilateral lesions). The extent of the mandibular canal bone defect on preoperative coronal computerized tomography images and the number of inferior alveolar nerve fascicles in resected specimens were evaluated. Comparisons were made between the slight pain and extreme pain groups. In most of the patients in the extreme pain group, either mandibular canal bone defects were absent or entire circumferential defects were present; inferior alveolar nerve fascicles were either distinguishable or completely absent in the resected specimens. RESULTS Although there was no statistically significant association between extreme pain and computerized tomography or histopathologic findings, the histopathologically indistinguishable inferior alveolar nerve fascicles was significantly associated with slight pain. CONCLUSIONS The degree of degeneration of mandibular canal and inferior alveolar nerve may be associated with pain severity in patients with mandibular osteoradionecrosis.
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Affiliation(s)
- Yujiro Hiraoka
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Satoshi Wanifuchi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Manabu Shigeoka
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Uddin O, Studlack P, Akintola T, Raver C, Castro A, Masri R, Keller A. Amplified parabrachial nucleus activity in a rat model of trigeminal neuropathic pain. NEUROBIOLOGY OF PAIN 2018; 3:22-30. [PMID: 29862375 PMCID: PMC5973803 DOI: 10.1016/j.ynpai.2018.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The parabrachial (PB) complex mediates both ascending nociceptive signaling and descending pain modulatory information in the affective/emotional pain pathway. We hypothesized that PB hyperactivity influences chronic pain behavior after trigeminal nerve injury in rats. Following induction of neuropathic pain using the chronic constriction injury of the infraorbital nerve (CCI-ION) model, rats displayed spontaneous markers of pain and mechanical hyperalgesia extending beyond the receptive field of the injured nerve. PB neurons recorded from rats with CCI-ION displayed amplified activity, manifesting as significantly longer responses to sensory stimuli, compared to shams. These findings suggest that chronic neuropathic pain involves PB hyperactivity.
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Affiliation(s)
- Olivia Uddin
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States.,Program in Neuroscience, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States
| | - Paige Studlack
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States.,Program in Neuroscience, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States
| | - Titilola Akintola
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States
| | - Charles Raver
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States
| | - Alberto Castro
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States.,Program in Neuroscience, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States
| | - Radi Masri
- Program in Neuroscience, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States.,Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, 650 W. Baltimore St, Baltimore, MD 21201, United States
| | - Asaf Keller
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States.,Program in Neuroscience, University of Maryland School of Medicine, 20 Penn St, HSF-II S251, Baltimore, MD 21201, United States
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15
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Devine M, Hirani M, Durham J, Nixdorf DR, Renton T. Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:526-540. [PMID: 29426749 DOI: 10.1016/j.oooo.2017.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/20/2017] [Accepted: 12/29/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of the study was to systematically identify criteria used to diagnose patients with trigeminal nerve injury. STUDY DESIGN A systematic review of the literature registered in the PROSPERO database. Inclusion criteria were patients diagnosed with nerve injury of the sensory divisions of the maxillary or mandibular branches of the trigeminal nerve, with reported tests and criteria used for diagnosis and persistent pain or unpleasant sensation associated with nerve injury. RESULTS In total, 28 articles were included. Diagnostic tests included clinical neurosensory tests (89%), thermal quantitative sensory testing (QST; 25%), electromyography (7%), and patient interview (14%). Neuropathic pain was assessed by using the visual analogue scale (39%); patient use of neuropathic medication (7%); questionnaires, including McGill and PainDETECT (21%). Functional impact was assessed in 14% and psychological impact in 7% of articles. Methodology in performing clinical neurosensory tests, application of diagnostic terms and diagnostic grading of nerve injury was found to be inconsistent among the included articles, making direct comparison of results difficult. CONCLUSIONS Recommendations for assessment and diagnosis of trigeminal nerve injury have been made based on the best available evidence from the review. There is an urgent requirement for a consensus in diagnostic criteria, criteria for assessment, and outcome reporting among stakeholder organizations to improve knowledge in this field.
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Affiliation(s)
- Maria Devine
- Department of Oral Surgery, King's College London Dental Institute, London, UK.
| | - Murtaza Hirani
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Justin Durham
- Centre for Oral Health Research and School of Dental Sciences, Newcastle University. Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Donald R Nixdorf
- Department of Diagnostic and Biological Sciences, School of Dentistry, Department of Neurology, Medical School, University of Minnesota and HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK
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16
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Renton T. Risk assessment of M3Ms and decisions on ordering a CBCT and prescribing a coronectomy. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/denu.2017.44.10.957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tara Renton
- Professor of Oral Surgery, King's College London, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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17
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Tampin B, Bohne T, Callan M, Kvia M, Melsom Myhre A, Neoh EC, Bharat C, Slater H. Reliability of the English version of the painDETECT questionnaire. Curr Med Res Opin 2017; 33:741-748. [PMID: 28161985 DOI: 10.1080/03007995.2017.1278682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The painDETECT questionnaire (PD-Q) has been used widely for the identification of neuropathic pain (NeP); however, the reliability of the English version of the PD-Q has never been investigated. OBJECTIVE This study aimed to determine the reliability of the PD-Q pre- (T0) and immediately post- (T1) clinical consultation and at one-week follow-up (T2). METHODS We recruited 157 patients attending a Neurosurgery Spinal Clinic and Pain Management Department. Minor changes to PD-Q instructions were made to facilitate patient understanding; however, no changes to individual items or scoring were made. Intraclass correlation coefficients (ICCs) were used to assess the reliability of PD-Q total scores between T0-T1 and T0-T2; weighted kappa (κ) was used to assess the agreement of PD-Q classifications (unlikely NeP, ambiguous, likely NeP) between all time-points. To ensure stability of clinical pain, patients scoring ≤2 or ≥6 on the Patient Global Impression Scale (PGIC) at T2 were excluded from the T0-T2 analysis. RESULTS Accounting for missing data and exclusions (change in PGIC score), data for 136 individuals (mean [SD] age: 56.8 [15.2]; 54% male) was available, of whom n = 129 were included in the T0-T1 and n = 69 in the T0-T2 comparisons. There was almost perfect agreement between the PD-Q total scores at T0-T1 time-points (ICC 0.911; 95% CI: 0.882-0.941) and substantial agreement at T0-T2 (ICC 0.792; 95% CI: 0.703-0.880). PD-Q classifications demonstrated substantial agreement for T0-T1 (weighted κ: 0.771; 95% CI: 0.683-0.858) and for T0-T2 (weighted κ: 0.691; 95% CI: 0.553-0.830). Missing data was accounted in 13% of our cohort and over 42% of our patients drew multiple pain areas on the PD-Q body chart. CONCLUSION The English version of the PD-Q is reliable as a screening tool for NeP. The validity of the questionnaire is still in question and has to be investigated in future studies.
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Affiliation(s)
- B Tampin
- a Department of Physiotherapy , Sir Charles Gairdner Hospital , Perth , Western Australia
- b Department of Neurosurgery , Sir Charles Gairdner Hospital , Perth , Western Australia
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
- d Faculty of Business Management and Social Sciences , Hochschule Osnabrück, University of Applied Sciences , Osnabrück , Germany
| | - T Bohne
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - M Callan
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - M Kvia
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - A Melsom Myhre
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - E C Neoh
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - C Bharat
- e Centre for Applied Statistics, University of Western Australia , Perth , Western Australia
- f Department of Research, Sir Charles Gairdner Hospital , Perth , Western Australia
| | - H Slater
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
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18
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Abstract
The issues specific to trigeminal pain include the complexity of the region, the problematic impact on daily function and significant psychological impact (J Dent, 43, 2015, 1203). By nature of the geography of the pain (affecting the face, eyes, scalp, nose, mouth), it may interfere with just about every social function we take for granted and enjoy (J Orofac Pain, 25, 2011, 333). The trigeminal nerve is the largest sensory nerve in the body, protecting the essential organs that underpin our very existence (brain, eyes, nose, mouth). It is no wonder that pain within the trigeminal system in the face is often overwhelming and inescapable for the affected individual.
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Affiliation(s)
- T Renton
- Oral Surgery, Kings College London, London, UK
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Abstract
Background and objectives The painDETECT questionnaire (PD-Q), a simple and reliable screening questionnaire of neuropathic pain, was developed in 2004 in cooperation with the German Research Network on Neuropathic Pain. The initial aim was to implement quality management and to improve the situation of neuropathic pain (NeP) patients in Germany. The PD-Q proved immediately successful and was translated into and validated in multiple languages. Subsequently a comprehensive electronic system (PD) comprising various validated questionnaires with regard to pain typical comorbidities, such as function, sleep, mood or anxiety, was implemented Germany wide. We aimed to provide a comprehensive overview about the development and validation as well as the application of the PD-Q in various clinical conditions. Methods This overview is based on a literature search on English full-text papers using the term 'painDETECT' in Medline and PubMed covering the time period from 2006 to September 2015, amended with further publications cited in the retrieved publications or provided by the questionnaire developers. Results PD-Q as screening tool for NeP described in patients with lower back pain (8 studies), rheumatoid arthritis and osteoarthritis (10), thoracotomy (2 studies), tumor diseases (4 studies), fibromyalgia (4 studies), diverse musculoskeletal conditions (12 studies) and diverse other conditions (10 studies). In addition, the PD-Q was used in 9 studies that investigated the effect of drugs for the treatment of patients with a NeP component. Conclusion To date more than 300,000 patients were assessed, providing the basis for one of the world's largest datasets for chronic pain. Among others the extensive pool of PD-Q data triggered the idea of subgrouping patients on the basis of their individual sensory profiles which might in the future lead to a stratified treatment approach and ultimately to personalized therapy. Started as a healthcare utilization project in Germany, the PD-Q is nowadays used for clinical and research purposes around the world.
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Affiliation(s)
- Rainer Freynhagen
- a Zentrum für Anästhesiologie, Intensivmedizin, Schmerztherapie & Palliativmedizin, Benedictus Krankenhaus , Tutzing , Germany
- b Technische Universität, Klinik für Anästhesiologie , München , Germany
| | - Thomas R Tölle
- c Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität , München , Germany
| | | | - Ralf Baron
- e Neurologische Klinik und Poliklink, Christians-Albrechts-Universität , Kiel , Germany
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Amato F, Morrone EG, Lacquaniti G. Efficacy, safety and tolerance of subcutaneous injection of high dosages of diclofenac in patients with neuropathic non-cancer pain and neuropathic cancer pain: Data from a clinical setting. EUR J INFLAMM 2015. [DOI: 10.1177/1721727x15576850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Diclofenac sodium is widely used for its anti-inflammatory and analgesic effects in the symptomatic treatment of acute and chronic inflammatory and painful conditions. The present observational study was carried out to investigate efficacy, safety, and tolerability of a new subcutaneous (SC) 75 mg/1 mL diclofenac hydroxypropyl-β-cyclodextrin (HPβCD) formulation for the treatment of neuropathic pain both in patients without cancer and in patients with cancer. A total of 105 outpatients and inpatients with moderate to severe neuropathic pain related to cancer (CP) and non-cancer (NCP), were selected if Numeric Rating Scale (NRS) ⩾7 and Pain Detect (PD) >16, and treated with 75 mg/1 mL SC HPβCD, according to a real clinical setting. The analgesic efficacy of the treatment, which was assessed during the study by questionnaire, was expressed in terms of reduction of 30–50% and >50% of baseline pain (NRS), after 1.5 h and 4 h from drug administration; tolerability and safety were assessed as well, and adverse events were recorded by an expert panel. In our study, a significant reduction in pain intensity (PI) after 1.5 h and after 4 h was observed for both groups of patients (CP and NCP). Different from what was detected in the CP group, a further and significant reduction of PI was obtained in the NCP group at 4 h ( P <0.039). With regard to tolerability, while 90% of the patients did not complain of any adverse drug reactions, only 10% reported mild transient adverse reactions. SC administration of HPβCD has been proven effective and safe in the treatment of patients with moderate to severe neuropathic pain related to cancer or not, in a real clinical setting.
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Affiliation(s)
- F Amato
- Hospital Emergency Services, Cosenza, Italy
| | - EG Morrone
- Pain Therapy Study Center, Cosenza, Italy
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Abstract
The year 2013-2014 has been designated the Global Year Against Orofacial Pain by the International Association for the Study of Pain. Accordingly, a multidisciplinary Canadian and international group of clinical, research and knowledge-transfer experts attended a workshop in Montreal, Quebec. The workshop had two aims: to identify new pathways for innovative diagnosis and management of chronic orofacial pain states; and to identify opportunities for further collaborative orofacial pain research and education in Canada. Three topics related to chronic orofacial pain were explored: biomarkers and pain signatures for chronic orofacial pain; misuse of analgesic and opioid pain medications for managing chronic orofacial pain; and complementary alternative medicine, topical agents and the role of stress in chronic orofacial pain. It was determined that further research is needed to: identify biomarkers of chronic orofacial post-traumatic neuropathic pain, with a focus on psychosocial, physiological and chemical-genetic factors; validate the short- and long-term safety (i.e., no harm to health, and avoidance of misuse and addiction) of opioid use for two distinct conditions (acute and chronic orofacial pain, respectively); and promote the use of topical medications as an alternative treatment in dentistry, and further document the benefits and safety of complementary and alternative medicine, including stress management, in dentistry. It was proposed that burning mouth syndrome, a painful condition that is not uncommon and affects mainly postmenopausal women, should receive particular attention.
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Affiliation(s)
| | - Barry J Sessle
- Correspondence: Dr Gilles J Lavigne, Faculté de medecine dentaire, Universite de Montreal, CP 6128, Succ Centre ville, Montreal, Quebec H3C 3J7. Telephone 514-343-6005, fax 514-343-2233, e-mail
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Cappelleri JC, Bienen EJ, Koduru V, Sadosky A. Measurement properties of painDETECT by average pain severity. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:497-504. [PMID: 25395867 PMCID: PMC4226388 DOI: 10.2147/ceor.s68997] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Since the burden of neuropathic pain (NeP) increases with pain severity, it is important to characterize and quantify pain severity when identifying NeP patients. This study evaluated whether painDETECT, a screening questionnaire to identify patients with NeP, can distinguish pain severity. Materials and methods Subjects (n=614, 55.4% male, 71.8% white, mean age 55.5 years) with confirmed NeP were identified during office visits to US community-based physicians. The Brief Pain Inventory – Short Form stratified subjects by mild (score 0–3, n=110), moderate (score 4–6, n=297), and severe (score 7–10, n=207) average pain. Scores on the nine-item painDETECT (seven pain-symptom items, one pain-course item, one pain-irradiation item) range from −1 to 38 (worst NeP); the seven-item painDETECT scores (only pain symptoms) range from 0 to 35. The ability of painDETECT to discriminate average pain-severity levels, based on the average pain item from the Brief Pain Inventory – Short Form (0–10 scale), was evaluated using analysis of variance or covariance models to obtain unadjusted and adjusted (age, sex, race, ethnicity, time since NeP diagnosis, number of comorbidities) mean painDETECT scores. Cumulative distribution functions on painDETECT scores by average pain severity were compared (Kolmogorov–Smirnov test). Cronbach’s alpha assessed internal consistency reliability. Results Unadjusted mean scores were 15.2 for mild, 19.8 for moderate, and 24.0 for severe pain for the nine items, and 14.3, 18.6, and 22.7, respectively, for the seven items. Adjusted nine-item mean scores for mild, moderate, and severe pain were 17.3, 21.3, and 25.3, respectively; adjusted seven-item mean scores were 16.4, 20.1, and 24.0, respectively. All pair-wise comparisons of scores between pain-severity groups showed sizable and statistically significant differences (P<0.0001). Cumulative distribution functions showed distinct separation between severity (P<0.0001). Cronbach’s alphas were 0.76 and 0.80 for the nine- and seven-item scales, respectively. Conclusion This study provides strong psychometric evidence on the validity and reliability of painDETECT for distinguishing average pain severity in patients with NeP.
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