Vol 58, No 1 (2024)
Research Paper
Published online: 2024-01-04

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Translation and cross-cultural adaptation of Polish version of Neuropathic Pain Questionnaire (NPQ-PL) and its comparisons with different questionnaires

Anna K. Szewczyk12, Anna Jamroz-Wiśniewska2, Klara Gonet3, Konrad Rejdak2
Pubmed: 38175147
Neurol Neurochir Pol 2024;58(1):66-74.


Aim of the study. The aim of this study was to assess the validity and reliability of the Polish version of the Neuropathic Pain Questionnaire (NPQ-PL), and to compare it to other diagnostic tools.

Clinical rationale for the study. Neuropathic pain is a burdensome condition, of which the exact prevalence is difficult to estimate. During initial screening, pain questionnaires are helpful in alerting clinicians about the need for further evaluation.

Material and methods. The NPQ-PL has been developed following the guidelines for translation and cultural adaptation. A total of 140 patients with chronic pain (ChP), 90 with neuropathic pain (NP), and 50 with nociceptive pain (NoP), were enrolled into this study.

Results. The study group consisted of 60.71% women and 39.29% men; the mean age of patients (standard deviation, SD) was 53.22 years (15.81), and the average NPQ-PL score (SD) was 0.49 (1.27). Statistically significant relationships were found between higher age distribution and greater pain intensity in the NP group compared to the NoP group. There were also significant differences in pain levels between people of different ages, with the predominance in the elderly. Cronbach’s alpha coefficient of the whole questionnaire was 0.85 and the intraclass correlation coefficient (ICC) for test-retest reliability was 0.635. Using receiver-operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.97 and the best cut-off value was 0.002, which resulted in the highest sensitivity (93.3%) and specificity (96.0%).

Conclusions and clinical implications. The NPQ-PL is a valid tool for discriminating between neuropathic and nociceptive pain. It can be used by physicians of various disciplines when assessing patients with ChP of various origins.

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  1. Bouhassira D, Lantéri-Minet M, Attal N, et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008; 136(3): 380–387.
  2. van Hecke O, Austin SK, Khan RA, et al. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014; 155(4): 654–662.
  3. Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain. 2015; 156(6): 1003–1007.
  4. Scholz J, Finnerup N, Attal N, et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. 2019; 160(1): 53–59.
  5. Smith BH, Torrance N. Epidemiology of neuropathic pain and its impact on quality of life. Curr Pain Headache Rep. 2012; 16(3): 191–198.
  6. Smith BH, Torrance N, Bennett MI, et al. Health and quality of life associated with chronic pain of predominantly neuropathic origin in the community. Clin J Pain. 2007; 23(2): 143–149.
  7. Attal N, Lanteri-Minet M, Laurent B, et al. The specific disease burden of neuropathic pain: results of a French nationwide survey. Pain. 2011; 152(12): 2836–2843.
  8. Häuser W, Wolfe F, Henningsen P, et al. Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population - a cross-sectional survey. BMC Public Health. 2014; 14: 352: 1–8.
  9. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011; 11: 770.
  10. de Sola H, Salazar A, Dueñas M, et al. Nationwide cross-sectional study of the impact of chronic pain on an individual's employment: relationship with the family and the social support. BMJ Open. 2016; 6(12): e012246.
  11. Jensen T, Baron R, Haanpää M, et al. A new definition of neuropathic pain. Pain. 2011; 152(10): 2204–2205.
  12. Bouhassira D. Neuropathic pain: Definition, assessment and epidemiology. Revue Neurologique. 2019; 175(1-2): 16–25.
  13. Di Stefano G, Di Lionardo A, Di Pietro G, et al. Neuropathic pain related to peripheral neuropathies according to the IASP grading system criteria. Brain Sci. 2021; 11(1): 1–8.
  14. Shinu P, Morsy MA, Nair AB, et al. Novel therapies for the treatment of neuropathic pain: potential and pitfalls. J Clin Med. 2022; 11(11).
  15. Baron R, Förster M, Binder A, et al. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010; 9(8): 807–819.
  16. Finnerup NB, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016; 157(8): 1599–1606.
  17. Haanpää M, Attal N, Backonja M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011; 152(1): 14–27.
  18. Breivik H, Collett B, Ventafridda V, et al. Survey of chronic pain in Europe: prevalence, impact on dialy life, and treatment. Eur J Pain. 2006; 10: 287–333.
  19. Siuda J, Boczarska-Jedynak M, Budrewicz S, et al. Validation of the Polish version of the Unified Dyskinesia Rating Scale (UDysRS). Neurol Neurochir Pol. 2021; 55(2): 186–194.
  20. Betscher E, Guenter W, Langdon DW, et al. Polish validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS battery): correlation of cognitive impairment with mood disorders and fatigue. Neurol Neurochir Pol. 2021; 55(1): 59–66.
  21. Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. Clin J Pain. 2003; 19(5): 306–314.
  22. Jones RC, Backonja MM. Review of neuropathic pain screening and assessment tools. Curr Pain Headache Rep. 2013; 17(9): 363.
  23. Hallström H, Norrbrink C. Screening tools for neuropathic pain: can they be of use in individuals with spinal cord injury? Pain. 2011; 152(4): 772–779.
  24. Li J, Feng Yi, Han J, et al. Linguistic adaptation, validation and comparison of 3 routinely used neuropathic pain questionnaires. Pain Physician. 2012; 15(2): 179–186.
  25. Yurdakul OV, Rezvani A, Kucukakkas O, et al. Neuropathic Pain Questionnaire and Neuropathic Pain Questionnaire-Short Form: translation, reliability, and validation study of the Turkish version. Turk Neurosurg. 2019; 29(5): 683–688.
  26. Shafiee E, Farzad M, Khodabandeh B, et al. Psychometric properties of the Persian version of the neuropathic pain questionnaire. Disabil Rehabil. 2021; 44(20): 6065–6069.
  27. Bennett MI, Smith BH, Torrance N, et al. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005; 6(3): 149–158.
  28. Cnotliwy M, Jurewicz A, Gołąb-Janowska M, et al. Próba adaptacji kwestionariusza Self-Complete of Leeds Assessment of Neuropathic Symptoms and Signs dla polskiej populacji. Pomeranian J Life Sci. 2016; 62(2): 18–21.
  29. Hjermstad MJ, Fayers PM, Haugen DF, et al. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011; 41(6): 1073–1093.
  30. Bielewicz J, Daniluk B, Kamieniak P. VAS and NRS, same or different? Are visual analog scale values and numerical rating scale equally viable tools for assessing patients after microdiscectomy? Pain Res Manag. 2022.
  31. Berko A, Bar-Sella A, Fisher H, et al. Development and evaluation of the HRSD-D, an image-based digital measure of the Hamilton rating scale for depression. Sci Rep. 2022; 12(1).
  32. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiat. 1960; 23(1): 56–62.
  33. Zimmerman M, Martinez JH, Young D, et al. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord. 2013; 150(2): 384–388.
  34. Beaton DE, Bombardier C, Guillemin F, et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000; 25(24): 3186–3191.
  35. Altman D. Practical statistics for medical research. Chapman and Hall/CRC, London 1991.
  36. Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med. 2018; 18(3): 91–93.
  37. Bobak CA, Barr PJ, O'Malley AJ. Estimation of an inter-rater intra-class correlation coefficient that overcomes common assumption violations in the assessment of health measurement scales. BMC Med Res Methodol. 2018; 18(1): 1–11.
  38. Li C, Chen J, Qin G. Partial Youden index and its inferences. J Biopharm Stat. 2019; 29(2): 385–399.
  39. DiBonaventura MD, Sadosky A, Concialdi K, et al. The prevalence of probable neuropathic pain in the US: results from a multimodal general-population health survey. J Pain Res. 2017; 10: 2525–2538.
  40. Torrance N, Ferguson JA, Afolabi E, et al. Neuropathic pain in the community: more under-treated than refractory? Pain. 2013; 154(5): 690–699.
  41. Bouhassira D, Attal N. Diagnosis and assessment of neuropathic pain: the saga of clinical tools. Pain. 2011; 152(3 Suppl): S74–S83.
  42. Bennett MI, Attal N, Backonja MM, et al. Using screening tools to identify neuropathic pain. Pain. 2007; 127(3): 199–203.
  43. Freynhagen R, Rey R, Argoff C. When to consider "mixed pain"? The right questions can make a difference! Curr Med Res Opin. 2020; 36(12): 2037–2046.
  44. Freynhagen R, Parada H, Calderon-Ospina C, et al. Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin. 2019; 35(6): 1011–1018.
  45. Mathieson S, Maher CG, Terwee CB, et al. Neuropathic pain screening questionnaires have limited measurement properties. A systematic review. J Clin Epidemiol. 2015; 68(8): 957–966.
  46. Türkel Y, Türker H, Demir IA, et al. Validation of self report version of the Leeds Assessment of Neuropathic Symptoms and Signs score for identification of neuropathic pain in patients from northern Turkey. Adv Clin Exp Med. 2014; 23(4): 599–603.
  47. Elzahaf RA, Tashani OA, Unsworth BA, et al. Translation and linguistic validation of the self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) scale for use in a Libyan population. Pain Pract. 2013; 13(3): 198–205.
  48. Harifi G, Ouilki I, El Bouchti I, et al. Validity and reliability of the Arabic adapted version of the DN4 questionnaire (Douleur Neuropathique 4 Questions) for differential diagnosis of pain syndromes with a neuropathic or somatic component. Pain Pract. 2011; 11(2): 139–147.
  49. Pickering G, Marcoux M, Chapiro S, et al. An algorithm for neuropathic pain management in older people. Drugs Aging. 2016; 33(8): 575–583.
  50. Dworkin RH, Jensen MP, Gammaitoni AR, et al. Symptom profiles differ in patients with neuropathic versus non-neuropathic pain. J Pain. 2007; 8(2): 118–126.
  51. Dagnino APA, Campos MM. Chronic pain in the elderly: mechanisms and perspectives. Front Hum Neurosci. 2022; 16.
  52. González-Roldán AM, Terrasa JL, Sitges C, et al. Age-related changes in pain perception are associated with altered functional connectivity during resting state. Front Aging Neurosci. 2020; 12.
  53. Lautenbacher S. Experimental approaches in the study of pain in the elderly. Pain Med. 2012; 13 (Suppl 2): S44–S50.
  54. Zis P, Daskalaki A, Bountouni I, et al. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging. 2017; 12: 709–720.
  55. Scherer M, Hansen H, Gensichen J, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract. 2016; 17: 1–8.
  56. Mossey JM, Gallagher RM. The longitudinal occurrence and impact of comorbid chronic pain and chronic depression over two years in continuing care retirement community residents. Pain Med. 2004; 5(4): 335–348.
  57. Cherif F, Zouari HG, Cherif W, et al. Depression prevalence in neuropathic pain and its impact on the quality of life. Pain Res Manag. 2020; 2020.
  58. Arango-Dávila C, Rincón-Hoyos H. Depressive disorder, anxiety disorder and chronic pain: multiple manifestations of a common clinical and pathophysiological core. Rev Colomb Psiquiatr (English ed.). 2018; 47(1): 46–55.
  59. Zheng CJ, Van Drunen S, Egorova-Brumley N. Neural correlates of co-occurring pain and depression: an activation-likelihood estimation (ALE) meta-analysis and systematic review. Transl Psychiatry. 2022; 12(1).

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