How would you assess your pain now, at this moment? 0. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 none max. How strong was the strongest pain during the past 4 weeks? 0. 1. Address for correspondence: Dr R. Freynhagen, MD, DEAA Klinik für Anästhesiologie,. Universitätsklinikum Düsseldorf, Moorenstraße 5, Date: ______ Patient: Last name: First name: '. How would you assess your pain now, at this moment? 0. 1. 2. 3. 4. 5. 6. 7. 8. 9. Please mark your main area.
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The painDETECT questionnaire is a patient-completed screening tool with utility for identification of neuropathic For the patients included in the analysis, the painDETECT had a modest ability to detect Download PDF. The painDETECT questionnaire was specifically developed to detect neuropathic pain components in adult patients with low back pain (Freynhagen et al ). PDF | On Jun 1, , Stephanie Mathieson and others published painDETECT questionnaire. Download full-text PDF. Content uploaded by.
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Analysis of sex differences in pain reporting did not identify any significant differences between men and women Figure 2.
When asked about their current pain compared with worst ever pain in their joints, a significant number of participants reported an improvement in their pain reporting at current levels Figure 2B , suggesting that the majority of subjects had experienced higher pain levels previously. We also assessed the group for evidence of obesity by body mass index BMI , since higher levels of obesity are known to correlate with higher pain reporting.
Participants were subgrouped by BMI into normal, overweight, and obese. The number N of participants within each BMI category is given. The results of the painDETECT questionnaire divided subjects into three groups: unlikely neuropathic pain, possible neuropathic pain, and likely neuropathic pain.
Interestingly, participants in the possible neuropathic pain group also demonstrated high VAS reporting, with a mean VAS of Discussion We have found that high levels of pain reporting exist in RA in people with fairly well-controlled disease activity measured by DAS Neuropathic pain classically refers to pain that is arising from the central nervous system, and it could be, as demonstrated by our study, that people with RA are sensitized to pain very early on in their disease.
Our data suggest that there may be a noninflammatory or neuropathic component that is mediating certain components of pain perception in RA.
The use of analgesic medications in the moderate and severe pain groups was the highest. Clinically, RA is identified with synovitis, which classically corresponds with inflammation-driven pain. Studies have shown that inflammation of the synovium leads to an acceleration of prostaglandin and bradykinin production, which leads to the activation of thin unmyelinated sensory nerves C fibers in the synovium. However, several studies, including the data herein, suggest that despite sufficient suppression of inflammation, there is still persistent pain even with the treatment of anti-inflammatory drugs, indicating that other factors mediating pain perception are involved in RA.
The enhanced response to stimulation of joints that are inflamed could be mediated by peripheral sensitization. Central sensitization is when normal inputs begin to produce aberrant feedback due to the excitation of the neurons in the central nervous system.
From our results, we have identified that people with RA prescribed a combination of biologics and DMARDs had an overall high mean VAS score compared with the other groups, despite DAS28 scores suggesting good control of disease activity. This finding further suggests that there may be additional factors involved in RA pain processing other than inflammation alone.
A reduction in DAS28 of 1. Together with agents such as nonsteroidal anti-inflammatory drugs, they help to limit and control the symptoms of RA. Additional analgesic agents that were reported to be of high usage in our study included paracetamol and codeine can also be given in combination, known as co-codamol.
If they showed evidence of likely neuropathic pain, it could be addressed potentially with a trial of analgesics targeted at neuropathic pain. Potential limitations of our study are that numbers of patients were relatively small with participants recruited.
However, this was a feasibility study to test the practicality of using the VAS and painDETECT in a clinical setting where many parameters are already being used to assess patients, including DAS28, blood tests, and clinical examinations.
However, physicians should be vigilant about possible false-positive diagnoses. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the paper. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: We have read the journal's policy and the authors of this manuscript have the following competing interests: M.
Nikaido, M. Sekiguchi and S.
Konno do not have any competing interests to declare. In preparing the manuscript, medical writing assistance was provided by Clinical Study Support, Inc. None of the authors have relationships with these entities regarding employment, consultancy, patents, products in development, and marketed products.
There are no patents, products in development or marketed products to declare. Neuropathic pain impairs sleep and increases the levels of anxiety and depression [ 4 ].
Because a different treatment approach is required for a different type of pain [ 6 ], early identification of the involvement of neuropathic pain in patients with chronic pain is important in the appropriate management of such patients [ 7 , 8 ]. However, the diagnosis of neuropathic pain is difficult, especially for non-specialists in primary care settings, because various underlying mechanisms can be responsible for its development and it may coexist with other types of pain such as nociceptive or psychogenic pain [ 7 ].
Previous reports suggested that neuropathic pain is underdiagnosed and undertreated [ 9 , 10 ]. The painDETECT questionnaire PD-Q , one of the available screening tools for neuropathic pain [ 11 ], allows non-specialists to quickly identify potential patients with neuropathic pain [ 6 ].
The validated Japanese version of the PD-Q PDQ-J is also available [ 12 ]; however, it has been suggested that the PDQ-J may not have sufficient diagnostic utility in detecting neuropathic pain caused by spinal disorders [ 13 ].
A nationwide study in Japan previously reported that neuropathic pain was present in This high proportion highlights the need to properly identify neuropathic pain in these patients so that they can receive appropriate treatment early.