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Avoiding Catch-22

Authors :: Nick T van Dasselaar
Marcel J. Schenkels
Monique A H Steegers
Ewald M. Bronkhorst
Hans Timmerman
Oliver H.G. Wilder-Smith
André Wolff
Frank J P M Huygen
Kris Vissers
Anesthesiology
Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
Source :: Timmerman, H, Wolff, A P, Bronkhorst, E M, Wilder-Smith, O H G, Schenkels, M J, van Dasselaar, N T, Huygen, F J P M, Steegers, M A H & Vissers, K C P 2018, ' Avoiding Catch-22 : Validating the PainDETECT in a in a population of patients with chronic pain ', BMC Neurology, vol. 18, no. 1, 91 . https://doi.org/10.1186/s12883-018-1094-4, BMC Neurology, 18, 1, pp. 91, Timmerman, H, Wolff, A P, Bronkhorst, E M, Wilder-Smith, O H G, Schenkels, M J, van Dasselaar, N T, Huygen, F J P M, Steegers, M A H & Vissers, K C P 2018, ' Avoiding Catch-22 : validating the PainDETECT in a in a population of patients with chronic pain ', BMC Neurology, vol. 18, no. 1, pp. 91 . https://doi.org/10.1186/s12883-018-1094-4, BMC Neurology, 18(1). BioMed Central, BMC Neurology, BMC Neurology, 18, 91, BMC Neurology, Vol 18, Iss 1, Pp 1-14 (2018), BMC NEUROLOGY, 18:91. BioMed Central Ltd., BMC Neurology, 18:91. BioMed Central Ltd.
Publication Year :: 2018
Publisher :: BioMed Central Ltd., 2018.
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. Electronic supplementary material The online version of this article (10.1186/s12883-018-1094-4) contains supplementary material, which is available to authorized users.