Background & Aims

Although musculoskeletal nociceptive pain is prevalent following whiplash injury, the development of neuropathic pain (NP) symptoms has also been reported (1,2,3). Recent studies also have identified putative pathophysiological mechanisms for the development of whiplash NP (1,3). Nevertheless, the performance of NP screening questionnaires to detect NP components, presented as symptoms, after whiplash injury has not been analysed. The aim of this study was to assess the diagnostic performance of three screening NP questionnaires (Douleur Neuropathique 4 [DN4], self-administered Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS], and painDETECT questionnaire [PDQ]) to detect the presence of NP symptoms in the early stage of whiplash injury, as measured with the Neuropathic Pain Symptom Inventory (NPSI). 

Methods

A total of 50 participants with acute whiplash injury were recruited into the study following signed consent (see below for ethics authorization). Whiplash injury was assessed with the Whiplash Associated Disorder severity (WAD). NP components (symptoms) after whiplash injury were characterized one week after the injury with physician assessment using the Neuropathic Pain Symptom Inventory (NPSI [4]). Acute screening for neuropathic pain (NP) components were performed with the DN4 (5), S-LANSS (6) and painDETECT questionnaire (7). Data analysis was performed with SPSS (version 24.0).

Results

The mean age of the cohort was 40.3±12.5 (68% female) with a WAD (Quebec) classification of IIa (10%), IIb (38%) and III (52%) and a 7-day pain intensity of 7.4±1.6 (NRS: 0-10 units). The total NPSI symptom score correlated with the three screening questionnaires (DN4: rho=0.7, p<0.001; PDQ: rho=0.62, p<0.001; S-LANSS: rho=0.68, p<0.001). Although the three screening questionnaires showed an appropriate discriminant validity (AUC > 0.7), area under the curve (AUC) values for DN4 (AUC:0.87; p<0.001) and S-LANSS (AUC:0.88; p<0.001) indicated that both tools had an excellent discriminant validity for NP components in the early stages of whiplash injury. Additionally, the DN4 showed the highest sensitivity (87%) followed by S-LANSS (75%), while the S-LANSS and PDQ demonstrated the highest specificity (85% and 82%, respectively). 

Conclusions

Early detection of NP components after whiplash can be performed with the DN4, S-LANSS and painDETECT screening questionnaires in the early stages of injury. Nevertheless, the S-LANSS and DN4 tools are slightly better than the PainDETECT questionnaire to detect the presence of NP components measured as symptoms in the early stages of whiplash injury.
 

References

1.      Fundaun J, Kolski M, Baskozos G, Dilley A, Sterling M, Schmid AB. Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis. Pain. 2022;163(7):e789-e811. doi: 10.1097/j.pain.0000000000002509. 

2.      Sterling M, Pedler A. A neuropathic pain component is common in acute whiplash and associated with a more complex clinical presentation. Man Ther. 2009;14(2):173-9. doi: 10.1016/j.math.2008.01.009. 

3.      Serrano-Muñoz D, Galán-Arriero I, Ávila-Martín G, Gómez-Soriano J, Florensa J, García-Peris A, et al. Deficient Inhibitory Endogenous Pain Modulation Correlates With Periaqueductal Gray Matter Metabolites During Chronic Whiplash Injury. Clin J Pain. 2019;35(8):668-77. doi: 10.1097/AJP.0000000000000722. 

4.      Villoria J, Rodríguez M, Berro MJ, Stern A, Sánchez-Magro I. Psychometric validation of the neuropathic pain symptom inventory for its use in Spanish. J Pain Symptom Manage. 2011;42(1):134-46. doi: 10.1016/j.jpainsymman.2010.09.018. 

5.      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. doi: 10.1186/1477-7525-5-66. 

6.      López-de-Uralde-Villanueva I, Gil-Martínez A, Candelas-Fernández P, de Andrés-Ares J, Beltrán-Alacreu H, La Touche R. Validity and reliability of the Spanish-language version of the self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. Neurologia (Engl Ed). 2018;33(8):505-14. doi: 10.1016/j.nrl.2016.10.009. 

7.      De Andrés J, Pérez-Cajaraville J, Lopez-Alarcón MD, López-Millán JM, Margarit C, Rodrigo-Royo MD, et al. Cultural adaptation and validation of the painDETECT scale into Spanish. Clin J Pain. 2012;28(3):243-53. doi: 10.1097/AJP.0b013e31822bb35b. 

 

Relevance for Patient Care

Early detection of NP components with the best performing screening questionnaires in individuals with acute whiplash injury will help to confirm symptoms and to develop preventive individualized treatment programs.

Ethical Permissions

This study was authorized by the Toledo Hospital Complex Clinical Ethics Committee (17/02/21, #2559/674).