Douleur Neuropathique 4 (DN4) is a screening questionnaire to help
identify neuropathic pain (NP) in clinical practice and research. We tested the
accuracy of the DN4 questionnaire in stratifying possible NP (pNP) and definite NP
(dNP) in patients operated for breast cancer.
We studied 163 patients from a longitudinal cohort of breast cancer
operated patients 4-9 years after surgery. pNP or dNP were classified according to
the NP grading system. Surgeon-verified intercostobrachial nerve resection was used
as a confirmatory test for dNP. A receiver-operating characteristic (ROC) curve
analysis was performed and the area under the curve (AUC) was calculated to test
the diagnostic accuracy (sensitivity, specificity, positive and negative predictive
values) of the DN4. Additionally, we studied clinical factors that associated with a
positive screening outcome in the interview part of the DN4 (DN4i).
DN4i and DN4 showed significant accuracy in stratifying patients with pNP
or dNP with cut-off scores 3 and 4 resulting to sensitivity of 66.2% and 79.4% and
specificity of 77.8% and 92.6%, respectively. pNP and dNP patients showed
differences in sensory descriptors of pain according to DN4i items. Screening
positive on DN4i associated with dNP and younger age.
Full DN4 could stratify pNP and dNP patients in a chronic postsurgical
NP patient group operated for breast cancer. Additionally, DN4i showed significant
accuracy in stratifying pNP and dNP, but an examination is necessary to obtain
proper accuracy. Demographic factors may have an impact on the screening
outcome of DN4i
