Avoiding Catch-22: validating the PainDETECT in a in a population of patients with chronic pain

Hans Timmerman; André P Wolff; Ewald M Bronkhorst; Oliver H G Wilder-Smith; Marcel J Schenkels; Nick T van Dasselaar; Frank J P M Huygen; Monique A H Steegers; Kris C P Vissers

doi:10.1186/s12883-018-1094-4

Avoiding Catch-22: validating the PainDETECT in a in a population of patients with chronic pain

Hans Timmerman
, André P Wolff
, Ewald M Bronkhorst
, Oliver H G Wilder-Smith
, Marcel J Schenkels
, Nick T van Dasselaar
, Frank J P M Huygen
, Monique A H Steegers
, Kris C P Vissers

Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Huispost 549, PO Box 9101, 6500, HB, Nijmegen, the Netherlands. [email protected].
Department of Anesthesiology, Pain Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands.
Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.
Bernhoven Ziekenhuis, Department of Anesthesiology, Uden, the Netherlands.
Reinier de Graaf Gasthuis, Department of Anesthesiology, Pain Medicine and Palliative Care, Delft, the Netherlands.
ErasmusMC, Department of Anesthesiology, University Center of Pain Medicine, Rotterdam, the Netherlands.
Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Huispost 549, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system and is a major therapeutic challenge. Several screening tools have been developed to help physicians detect patients with neuropathic pain. These have typically been validated in populations pre-stratified for neuropathic pain, leading to a so called "Catch-22 situation:" "a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule". The validity of screening tools needs to be proven in patients with pain who were not pre-stratified on basis of the target outcome: neuropathic pain or non-neuropathic pain. This study aims to assess the validity of the Dutch PainDETECT (PainDETECT-Dlv) in a large population of patients with chronic pain.

METHODS: A cross-sectional multicentre design was used to assess PainDETECT-Dlv validity. Included where patients with low back pain radiating into the leg(s), patients with neck-shoulder-arm pain and patients with pain due to a suspected peripheral nerve damage. Patients' pain was classified as having a neuropathic pain component (yes/no) by two experienced physicians ("gold standard"). Physician opinion based on the Grading System was a secondary comparison.

RESULTS: In total, 291 patients were included. Primary analysis was done on patients where both physicians agreed upon the pain classification (n = 228). Compared to the physician's classification, PainDETECT-Dlv had a sensitivity of 80% and specificity of 55%, versus the Grading System it achieved 74 and 46%.

CONCLUSION: Despite its internal consistency and test-retest reliability the PainDETECT-Dlv is not an effective screening tool for a neuropathic pain component in a population of patients with chronic pain because of its moderate sensitivity and low specificity. Moreover, the indiscriminate use of the PainDETECT-Dlv as a surrogate for clinical assessment should be avoided in daily clinical practice as well as in (clinical-) research. Catch-22 situations in the validation of screening tools can be prevented by not pre-stratifying the patients on basis of the target outcome before inclusion in a validation study for screening instruments.

TRIAL REGISTRATION: The protocol was registered prospectively in the Dutch National Trial Register: NTR 3030 .

Original language	English
Pages (from-to)	91
Journal	BMC neurology
Volume	18
Issue number	1
DOIs	https://doi.org/10.1186/s12883-018-1094-4
Publication status	Published - 29 Jun 2018

Keywords

Adult
Aged
Chronic Pain/diagnosis
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Neuralgia/diagnosis
Reproducibility of Results
Sensitivity and Specificity
Surveys and Questionnaires

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Cite this

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title = "Avoiding Catch-22: validating the PainDETECT in a in a population of patients with chronic pain",

abstract = "BACKGROUND: Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system and is a major therapeutic challenge. Several screening tools have been developed to help physicians detect patients with neuropathic pain. These have typically been validated in populations pre-stratified for neuropathic pain, leading to a so called {"}Catch-22 situation:{"} {"}a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule{"}. The validity of screening tools needs to be proven in patients with pain who were not pre-stratified on basis of the target outcome: neuropathic pain or non-neuropathic pain. This study aims to assess the validity of the Dutch PainDETECT (PainDETECT-Dlv) in a large population of patients with chronic pain.METHODS: A cross-sectional multicentre design was used to assess PainDETECT-Dlv validity. Included where patients with low back pain radiating into the leg(s), patients with neck-shoulder-arm pain and patients with pain due to a suspected peripheral nerve damage. Patients' pain was classified as having a neuropathic pain component (yes/no) by two experienced physicians ({"}gold standard{"}). Physician opinion based on the Grading System was a secondary comparison.RESULTS: In total, 291 patients were included. Primary analysis was done on patients where both physicians agreed upon the pain classification (n = 228). Compared to the physician's classification, PainDETECT-Dlv had a sensitivity of 80\% and specificity of 55\%, versus the Grading System it achieved 74 and 46\%.CONCLUSION: Despite its internal consistency and test-retest reliability the PainDETECT-Dlv is not an effective screening tool for a neuropathic pain component in a population of patients with chronic pain because of its moderate sensitivity and low specificity. Moreover, the indiscriminate use of the PainDETECT-Dlv as a surrogate for clinical assessment should be avoided in daily clinical practice as well as in (clinical-) research. Catch-22 situations in the validation of screening tools can be prevented by not pre-stratifying the patients on basis of the target outcome before inclusion in a validation study for screening instruments.TRIAL REGISTRATION: The protocol was registered prospectively in the Dutch National Trial Register: NTR 3030 .",

keywords = "Adult, Aged, Chronic Pain/diagnosis, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Neuralgia/diagnosis, Reproducibility of Results, Sensitivity and Specificity, Surveys and Questionnaires",

author = "Hans Timmerman and Wolff, \{Andr{\'e} P\} and Bronkhorst, \{Ewald M\} and Wilder-Smith, \{Oliver H G\} and Schenkels, \{Marcel J\} and \{van Dasselaar\}, \{Nick T\} and Huygen, \{Frank J P M\} and Steegers, \{Monique A H\} and Vissers, \{Kris C P\}",

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doi = "10.1186/s12883-018-1094-4",

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T1 - Avoiding Catch-22

T2 - validating the PainDETECT in a in a population of patients with chronic pain

AU - Timmerman, Hans

AU - Wolff, André P

AU - Bronkhorst, Ewald M

AU - Wilder-Smith, Oliver H G

AU - Schenkels, Marcel J

AU - van Dasselaar, Nick T

AU - Huygen, Frank J P M

AU - Steegers, Monique A H

AU - Vissers, Kris C P

PY - 2018/6/29

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N2 - BACKGROUND: Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system and is a major therapeutic challenge. Several screening tools have been developed to help physicians detect patients with neuropathic pain. These have typically been validated in populations pre-stratified for neuropathic pain, leading to a so called "Catch-22 situation:" "a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule". The validity of screening tools needs to be proven in patients with pain who were not pre-stratified on basis of the target outcome: neuropathic pain or non-neuropathic pain. This study aims to assess the validity of the Dutch PainDETECT (PainDETECT-Dlv) in a large population of patients with chronic pain.METHODS: A cross-sectional multicentre design was used to assess PainDETECT-Dlv validity. Included where patients with low back pain radiating into the leg(s), patients with neck-shoulder-arm pain and patients with pain due to a suspected peripheral nerve damage. Patients' pain was classified as having a neuropathic pain component (yes/no) by two experienced physicians ("gold standard"). Physician opinion based on the Grading System was a secondary comparison.RESULTS: In total, 291 patients were included. Primary analysis was done on patients where both physicians agreed upon the pain classification (n = 228). Compared to the physician's classification, PainDETECT-Dlv had a sensitivity of 80% and specificity of 55%, versus the Grading System it achieved 74 and 46%.CONCLUSION: Despite its internal consistency and test-retest reliability the PainDETECT-Dlv is not an effective screening tool for a neuropathic pain component in a population of patients with chronic pain because of its moderate sensitivity and low specificity. Moreover, the indiscriminate use of the PainDETECT-Dlv as a surrogate for clinical assessment should be avoided in daily clinical practice as well as in (clinical-) research. Catch-22 situations in the validation of screening tools can be prevented by not pre-stratifying the patients on basis of the target outcome before inclusion in a validation study for screening instruments.TRIAL REGISTRATION: The protocol was registered prospectively in the Dutch National Trial Register: NTR 3030 .

AB - BACKGROUND: Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system and is a major therapeutic challenge. Several screening tools have been developed to help physicians detect patients with neuropathic pain. These have typically been validated in populations pre-stratified for neuropathic pain, leading to a so called "Catch-22 situation:" "a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule". The validity of screening tools needs to be proven in patients with pain who were not pre-stratified on basis of the target outcome: neuropathic pain or non-neuropathic pain. This study aims to assess the validity of the Dutch PainDETECT (PainDETECT-Dlv) in a large population of patients with chronic pain.METHODS: A cross-sectional multicentre design was used to assess PainDETECT-Dlv validity. Included where patients with low back pain radiating into the leg(s), patients with neck-shoulder-arm pain and patients with pain due to a suspected peripheral nerve damage. Patients' pain was classified as having a neuropathic pain component (yes/no) by two experienced physicians ("gold standard"). Physician opinion based on the Grading System was a secondary comparison.RESULTS: In total, 291 patients were included. Primary analysis was done on patients where both physicians agreed upon the pain classification (n = 228). Compared to the physician's classification, PainDETECT-Dlv had a sensitivity of 80% and specificity of 55%, versus the Grading System it achieved 74 and 46%.CONCLUSION: Despite its internal consistency and test-retest reliability the PainDETECT-Dlv is not an effective screening tool for a neuropathic pain component in a population of patients with chronic pain because of its moderate sensitivity and low specificity. Moreover, the indiscriminate use of the PainDETECT-Dlv as a surrogate for clinical assessment should be avoided in daily clinical practice as well as in (clinical-) research. Catch-22 situations in the validation of screening tools can be prevented by not pre-stratifying the patients on basis of the target outcome before inclusion in a validation study for screening instruments.TRIAL REGISTRATION: The protocol was registered prospectively in the Dutch National Trial Register: NTR 3030 .

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KW - Aged

KW - Chronic Pain/diagnosis

KW - Cross-Sectional Studies

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neuralgia/diagnosis

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Surveys and Questionnaires

U2 - 10.1186/s12883-018-1094-4

DO - 10.1186/s12883-018-1094-4

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JO - BMC neurology

JF - BMC neurology

IS - 1

ER -

Avoiding Catch-22: validating the PainDETECT in a in a population of patients with chronic pain

Abstract

Keywords

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