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Open Access Highly Accessed Research article

Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study

Jarno Gauffin1*, Tiina Hankama2, Hannu Kautiainen34, Pekka Hannonen25 and Maija Haanpää67

Author Affiliations

1 ORTON Rehabilitation Centre, ORTON Foundation, Helsinki, Finland

2 Department of Medicine, Central Finland Central Hospital, Jyväskylä, Finland

3 Unit of Family Practice, Central Finland Central Hospital, Jyväskylä, Finland

4 Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland

5 University of Eastern Finland, School of Medicine, Kuopio, Finland

6 Etera Mutual Pension Insurance Company, Helsinki, Finland

7 Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland

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BMC Neurology 2013, 13:21  doi:10.1186/1471-2377-13-21

Published: 14 February 2013

Abstract

Backround

Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia.

Methods

158 patients with primary fibromyalgia underwent a neurological examination including bedside sensory testing. They also fulfilled four questionnaires: PainDETECT, Beck depression inventory IA (BDI IA), Fibromyalgia Impact Questionnaire (FIQ) and a self-made questionnaire regarding present pain and pain relieving methods of the patients. The results of the clinical evaluation and questionnaires were then compared.

Results

Clinically verified neuropathic pain was diagnosed in 53/158 [34% (95% Cl: 26 to 41)] patients. The ROC curve achieved a maximum Youden´s index at score of 17 when sensitivity was 0.79 (95% Cl: 0.66 to 0.89) and specificity 0.53 (95% Cl: 0.43 to 0.63). The PainDETECT total score (OR: 1.14 95% Cl: 1.06 to 1.22), FM as the worst current pain (OR: 0.31; 95% 0.16 to 0.62), body mass index (BMI) (OR: 1.05; 95% Cl: 1.00 to 1.11) and the intensity of current pain (OR: 1.20; 95% Cl: 1.01 to 1.41) were significantly associated with the presence of neuropathic pain in univariate analyses.

Conclusion

This study highlights the importance of thorough clinical examination. The Neuropathic pain screening tool PainDETECT is not as useful in patients with fibromyalgia as in patients with uncompromised central pain control.