Prevalence of pain and relative diagnostic performance of screening tools for neuropathic pain in cancer patients: A cross-sectional study
European Journal of Pain
Abstract
Background
Neuropathic
pain can be overlooked in cancer patients. The advent of screening
tools can help in recognizing it. However, little is known about their
relative diagnostic performance and factors that affect it. This study
evaluated the prevalence of neuropathic pain using several diagnostic
strategies in cancer patients undergoing chemotherapy.
Methods
Patients
attending the Oncology Unit of the investigators' site to continue
their chemotherapy schedule were systematically screened for this
cross-sectional study. Before starting chemotherapy drugs, pain
specialists made a clinical diagnosis of neuropathic pain (either
disease related, treatment related or comorbid) and medical oncologists
administered three validated screening tools. Their relative diagnostic
performance and the impact of some pain features on it were analysed
using multivariate statistical methods.
Results
From
a total of 358 patients, 194 (54.2%) suffered from pain and 73 (20.4%)
had a clinical diagnosis of pure neuropathic or mixed pain.
Among the screening tools, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was more specific (93.4%), although less sensitive (68.1%) than the Douleur Neuropathique in 4 Questions (DN4) (sensitivity: 87.5%, specificity: 88.4%).
Interestingly, the specificities of these two instruments did not differ in patients with mild pain, while the DN4 remained to be more sensitive than the LANSS regardless of pain severity.
Among the screening tools, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was more specific (93.4%), although less sensitive (68.1%) than the Douleur Neuropathique in 4 Questions (DN4) (sensitivity: 87.5%, specificity: 88.4%).
Interestingly, the specificities of these two instruments did not differ in patients with mild pain, while the DN4 remained to be more sensitive than the LANSS regardless of pain severity.
Conclusions
Neuropathic
pain is common in cancer patients undergoing chemotherapy. The DN4
might be of great help for the early detection of patients at risk
because of incipient chemotherapy-related neuropathies and the LANSS to
rule out neuropathic pain in patients with complex pain conditions.
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