Application of painDETECT in Pediatric Chronic Pain: How Well Does It Identify Neuropathic Pain and Its Characteristics?

Abstract

Pediatric neuropathic pain is difficult to diagnose, and when undetected is associated with functional disability, mental health concerns, and decreased quality of life. PainDETECT is a screening tool developed to differentiate neuropathic from nociceptive pain components, thus guiding treatment decision-making and improving outcomes. Therefore, the purpose of this study was to evaluate how well painDETECT can identify neuropathic pain and its characteristics in a pediatric population. Adolescents (10-24yo) were recruited from two major children's hospitals. Participants completed painDETECT and two quantitative sensory tasks (QST) that assess mechanical allodynia (brush) and pressure pain (algometer) as part of an ongoing study. Pain diagnoses were collected via parent report and participant medical chart, when unclear. Descriptive statistics and ANOVAs were used to characterize participants and assess painDETECT in relation to diagnosis and QST measures. Participants with chronic pain diagnoses (N=110, Mage=15.05±2.4, Nfemale=88) and peers without pain (N=55, Mage=15.84±3.9, Nfemale=39) were included. As expected, painDETECT scores for participants with pain (M=11.51±6.59) were higher than peers without pain (M=1.42±2.15). Among those diagnosed with neuropathic pain, painDETECT identified 88.5% as having neuropathic pain. Among those diagnosed with abdominal, endometriosis, and fibromyalgia, 75% were identified as having nociceptive pain and 0% as having neuropathic pain. For those diagnosed with musculoskeletal and pain amplification, 61% were identified as having nociceptive pain and 19.6% as having neuropathic pain. Individuals in the neuropathic pain category had significantly higher mechanical allodynia (p=.021) and lower pressure pain thresholds (p=.059). PainDETECT differentiated participants with pain from their peers without pain and demonstrated accuracy in identifying participants as having nociceptive vs. neuropathic pain, consistent with their existing pain diagnosis. Moreover, QST results were consistent with a positive neuropathic screening. Taken together, results support the use of painDETECT as a pediatric neuropathic pain screening tool. Grant support from 5R01HD83270.