Table 5.
Tools for identification and evaluation of symptoms of neuropathic pain and (painful) diabetic neuropathy
| Abbreviation | Full name | Objective(s) | Description | References |
|---|---|---|---|---|
| Neuropathic pain | ||||
| DN4 | Douleur Neuropathique en 4 Questions | To compare the clinical features of neuropathic and non-neuropathic pain |
Clinician-administered questionnaire (10 items): 7 sensory descriptors and 3 clinical signs related to bedside sensory examination, to be tested by the physician |
Bouhassira et al. (2005) Spallone et al. (2012) |
| DN4-interview | Douleur Neuropathique en 4 Questions-Interview | To compare the clinical features of neuropathic and non-neuropathic pain | Clinician-administered questionnaire (7 sensory descriptors) |
Bouhassira et al. (2005) Spallone et al. (2012) |
| NPSI | Neuropathic Pain Symptom Inventory | To evaluate the different dimensions of symptoms of neuropathic pain |
Patient self-administered questionnaire (12 items): items related to different pain descriptors (e.g., burning, electric-shock like, squeezing, tingling) |
Bouhassira et al. (2004) Crawford et al. (2008) Lucchetta et al. (2011) |
| PainDETECT | PainDETECT | Screening for the presence of neuropathic pain without physical examination |
Patient self-administered questionnaire (10 items): 1 item time course, 1 item pain intensity, 1 item pain radiation, 7 items pain descriptors (quality) |
Freynhagen et al. (2006) Themistocleous et al. (2016) |
| Painful diabetic neuropathy | ||||
| DN4 | Douleur Neuropathique en 4 Questions | To compare the clinical features of neuropathic and non-neuropathic pain |
Clinician-administered questionnaire (10 items): 7 sensory descriptors and 3 clinical signs related to bedside sensory examination, to be tested by the physician |
Bouhassira et al. (2005) Spallone et al. (2012) |
| DN4-interview | Douleur Neuropathique en 4 Questions-Interview | To compare the clinical features of neuropathic and non-neuropathic pain | Clinician-administered questionnaire (7 sensory descriptors) |
Bouhassira et al. (2005) Spallone et al. (2012) |
| mBPI-DPN | Modified Brief Pain Inventory | Modified version of the Brief pain Inventory for patients with painful diabetic neuropathy | Patient-completed numeric rating scale to assess the severity of pain, the impact on daily functioning and other aspects of pain. A modification was made to distinguish between pain attributable to diabetic polyneuropathy and attributable to other causes. | Zelman et al. (2005) |
| NSC-score | Neuropathy Symptom and Change Score | To detect and grade the severity of diabetic neuropathy and pain | Clinician-administered questions about the type of pain or slight illness, location of symptoms, time of symptom, arousal from sleep and maneuvers that are relieving patients’ symptoms | Xiong et al. (2015) |
| NTSS-6 | Total Symptom Score 6 | To evaluate the frequency and intensity of neuropathic sensory and pain symptoms in patients with diabetic peripheral neuropathy |
Clinician-administered 6-item questionnaire: frequency and intensity of: numbness and/or hyposensitivity; prickling and/or tingling; burning; aching pain and/or tightness; sharp, shooting, lancinating pain; and allodynia and/or hyperalgesia) |
Bastyr et al. (2005) |
| PainDETECT | PainDETECT | Screening for the presence of neuropathic pain without physical examination |
Patient self-administered questionnaire (10 items): 1 item time course, 1 item pain intensity, 1 item pain radiation, 7 items pain descriptors (quality) |
Freynhagen et al. (2006) Themistocleous et al. (2016) |
| Diabetic neuropathy | ||||
| CSS | Clinical screening score | To screen T2DM patients for sensorimotorpolyneuropathy and need for in-depth foot examination | Clinician-administered evaluation of risk factors, diastolic blood pressure, creatinine serum levels, foot inspection and interview for pain and neuropathic symptoms | Bongaerts et al. (2015) |
| DNE | Diabetic Neuropathy Examination Score | To diagnose distal diabetic polyneuropathy | Clinician-administered (8 item) examination about muscle strength, reflexes and sensations (pinprick, SWMF, vibration and proprioception) |
Meijer et al. (2000) Meijer et al. (2003) Liyanage et al. (2012) |
| DNS | Diabetic Neuropathy Symptom Score | To assess distal neuropathy in patients with diabetes |
Clinician-administered (4 item) symptom score: 1. Unsteadiness in walking, 2. Pain, burning or aching at legs or feet, 3. Prickling sensations in legs or feet and 4. Numbness in legs or feet |
Meijer et al. (2002) Liyanage et al. (2012) |
| mTCNS | Modified Toronto Clinical Neuropathy Score | To modify the TCSS to better capture a categorical scale of simple sensory tests which are representative of the early dysfunction in diabetic sensorimotorpolyneuropathy | Clinician-administered symptom scores and sensory test scores | Bril et al. (2009) |
| MNSI | Michigan Neuropathy Screening Instrument |
To screen large numbers of patients in a routine clinical setting for the presence of diabetic neuropathy Patients who screen positive on the MNSI may be referred for the administration of the MDNS |
Section A: self‐administered by the patient through 15 “yes” or “no” questions about foot sensation, numbness, temperature alterations, general asthenia, and peripheral vascular disease Section B: based on clinical examination (clinician-administered): (1) inspection of both feet (2) examination and grading of muscle stretch reflexes (3) determination of vibration sensation |
Feldman et al. (1994) Rahman et al. (2003) Moghtaderi et al. (2006) Xiong et al. (2015) Barbosa et al. (2017) Sartor et al. (2018) |
| MDNS | Michigan Diabetic Neuropathy Score | To provide a means of diagnosing and staging diabetic neuropathy that is simpler and less time consuming than accepted research protocols | Clinician-administered sensory impairment testing, muscle strength testing and reflexes | Feldman et al. (1994) |
| NDS | Neuropathy Disability Score | To detect deficits affecting the peripheral nervous system | Clinician-administered evaluation of cranial nerves, muscle weakness, reflexes and loss of sensations | Dyck et al. (1980) |
| Norfolk QoL-DN | Norfolk Quality of life questionnaire – diabetic neuropathy | To capture the entire spectrum of diabetic neuropathy including sensory loss of function, balance, motor impairments and autonomic symptoms | Patient self-administered description of symptoms and complications and their duration, generic health status | Vinik et al. (2005) |
| NSS | Neuropathy Symptom Score | To detect and grade the severity of diabetic neuropathy based on a recorded evaluation of neurological symptoms | Clinician-administered testing of muscle weakness, sensory disturbances, and autonomic signs |
Dyck (1988) Dyck et al. (1980) |
| TNS | Total Neuropathy Score | To grade severity of diabetic polyneuropathy | Clinician-administered composite measure of peripheral nerve function combining the grading of symptoms, signs, nerve conduction studies and quantitative sensory testing | Cornblath et al. (1999) |
| TCSS | Toronto Clinical Scoring System | To examine the presence and severity of diabetic peripheral sensorimotor polyneuropathy as assessed via electrophysiological criteria and myelinated fiber density on sural nerve biopsy | Clinician-administered classical neurological history (symptom scores) and examination techniques (reflex scores and sensory test scores) and designed to be simple and relevant to the clinician | Bril and Perkins (2002) |
Validity is inconsistent and not fully convincing, as different reference standards were used. Thus, validity is not always sufficient for daily clinical practice. In these tests, pDN is often not included in validation, mostly only neuropathic symptoms are assessed but not pain in particular. This table is not exhaustive. References refer to first description of the instrument and/or, if available, to validation studies in diabetic patients