Is neuropathic pain underdiagnosed in musculoskeletal pain conditions? The Danish PainDETECTive study

Abstract

In all, 19–22% of the adult Danish population suffer from chronic pain – most frequently in the musculoskeletal system. Different pain management strategies depending on pain mechanism (neuropathic/nociceptive) make diagnosing the pain condition especially important.

Objectives:

To investigate whether a validated, self-administered questionnaire (PainDETECT) helps specialists and general practitioners in Denmark identify patients with neuropathic pain components (NeP).

Research design and methods:

In a non-interventional study a sample of Danish specialists (rheumatologists and anaesthesiologists) and general practitioners used the PainDETECT questionnaire on 1322 chronic pain patients. PainDETECT was filled in by patients and scored by the physician. A PainDETECT score above 18 indicates the presence of NeP.

Results:

A total of 87–95% of the included chronic pain patients (702 by specialists (mean age: 56 years) and 620 by general practitioners (mean age: 55 years)) had musculoskeletal pain. In 39–43% of these patients NeP components were present as assessed by PainDETECT (score 21.1–21.7). One-third of the 540 NeP patients (31–36%) had their pain diagnosis reclassified from a non-NeP to a predominant/mixed NeP diagnosis after use of PainDETECT.

Conclusions:

Neuropathic pain seems to be underdiagnosed in musculoskeletal pain conditions. Use of the PainDETECT instrument may be of help to general practitioners and specialists when diagnosing NeP in chronic pain patients. However, the fact that no neurologists were included, together with the limited sample size, with large variations in the number of patients each physician included, as well as the lack of a strict consecutive recruitment process are study limitations.

Key words::

• Musculoskeletal
• Neuropathic pain
• PainDETECT
• Questionnaire
• Screening

Transparency

Declaration of funding

Pfizer Denmark Aps. and the Oak Foundation (in relation to the Parker Institute, Frederiksberg Hospital) funded this project. Together with a project steering committee including all co-authors, employees from Pfizer Denmark has participated in the project, i.e. in its design, data collection, data analysis and manuscript writing.

Declaration of financial/other relations

All co-authors declared that they have been members of a steering committee sponsored by Pfizer Denmark Aps. The involvement of K.A., S.A., B.L. and H.B. with Pfizer Denmark Aps. in the project was approved by the Danish Medicines Agency according to existing rules and they were paid a consultancy fee for their participation. H.J. and P.B.P. have declared that they are employees of Pfizer Denmark Aps. Peer reviewers may receive honoraria from CMRO for their review work. The peer reviewers have disclosed no relevant financial interests.

The study was presented as an oral presentation at the Annual European Congress of Rheumatology (EULAR), Copenhagen, Denmark, June 10–13, 2009.