This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Two kinds of pain
Most pain is nociceptive: it comes from tissue damage, such as a sprain, arthritis or a wound, and the nervous system works normally to report it. Neuropathic pain is different: it comes from damage to the nerves themselves. It feels different, often burning, electric or tingling, and responds to different treatments. Recognizing it early avoids months of ineffective painkillers.
The DN4 questionnaire
The DN4, short for douleur neuropathique en 4 questions, was developed in France by Didier Bouhassira and colleagues and published in 2005. It has 10 items grouped into 4 questions:
Interview
- Does the pain have one or more of these characteristics? Burning; painful cold; electric shocks.
- Is the pain associated with one or more of these symptoms in the same area? Tingling; pins and needles; numbness; itching.
Examination
- Is the pain located in an area where the examination finds reduced feeling to touch, or reduced feeling to pinprick?
- Is the pain caused or increased by brushing the skin?
Each yes scores 1 point.
Interpretation
A total of 4 or more out of 10 suggests neuropathic pain. In the original study of 160 patients, this cut-off correctly identified 82.9% of patients with neuropathic pain and 89.9% of those without. A shorter interview-only version, the DN4-interview, uses a cut-off of 3 out of 7.
Example
A person with diabetes describes burning feet with tingling and numbness. On examination, light touch is felt less in the painful area. That makes 4 points: neuropathic pain is likely, consistent with diabetic peripheral neuropathy.
What happens next
A doctor confirms the diagnosis and looks for the cause: diabetes, shingles, a compressed nerve root, nerve injury after surgery, chemotherapy, vitamin B12 deficiency, alcohol or a neurological disease. Treatment options include:
- antidepressants such as duloxetine or amitriptyline;
- anticonvulsants such as gabapentin or pregabalin;
- topical treatments such as lidocaine or high-dose capsaicin patches;
- physical therapy, nerve stimulation and psychological approaches.
Limits
The DN4 is a screening tool. Some pains are mixed, with both neuropathic and nociceptive parts, such as chronic low back pain with sciatica. A score below 4 does not exclude neuropathic pain if the history and examination suggest it.