The painDETECT questionnaire, when used in secondary care, may not be adapted for the identification of the neuropathic components of orofacial pain and may underestimate the complexity of this condition, according to a study published in the Journal of Headache Pain.
Specialty dentists recruited a total of 251 patients with acute pain and >1 orofacial pain site who attended a secondary care center. Patients were asked to complete a paper-based painDETECT questionnaire before consultation. Responses on the painDETECT were compared with the clinical diagnosis from a pain expert, which included pain etiology (neuropathic origin, mixed etiology, or non-neuropathic). PainDETECT scores ≥12, ≥19, and 12 to 19 indicated a neuropathic component, a probable neuropathic component, and the possible yet uncertain presence of a neuropathic component, respectively.
The painDETECT was found to be modestly beneficial in identifying the neuropathic components of orofacial pain as assessed by the area under the receiver operating characteristics (P =.001). The questionnaire had a sensitivity of 59.6%, a 56.9% specificity, a 62.4% positive predictive value, and a 53.5% negative predictive value. A secondary diagnosis was the only patient characteristic found to contribute to the painDETECT score after adjusting for sociodemographic factors (β = − 0.18; P =.006). The painDETECT questionnaire was found to underperform in identifying patients with mixed pain etiologies.
Limitations of the study include the small number of participants and the lack of data on the time between first consultation diagnosis and independent clinical confirmation.
“Prior to clinical and further research applications, the [painDETECT questionnaire] must be adapted and revalidated for [patients with] orofacial pain, and separately in primary care, where orofacial pain is considerably less common,” noted the investigators. “Ultimately, either patient-completed screening tools should only be implemented within settings they were designed, or pre-existing general screening tools needs to be optimized in different settings to reflect the variety of clinical situations for which such tools may be applicable.”
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(1):103.