- Neurology
- General medicine
DN4 score
Identifying neuropathic pain
The DN4 helps identify a neuropathic component of pain. Its full version combines an interview on the pain characteristics and a clinical examination of the affected area. It is not a self-administered questionnaire that can be completed entirely by the patient.
- Number of questions
- 4 questions comprising 10 items
- Approximate duration
- A few minutes
- Population
- Adults presenting with pain to be characterized
- Modality
- Consultation and examination by a healthcare professional
QuestionnaireDN4
CLINICIAN SCORE
Seven interview items explore the sensations associated with pain. The other three items require clinical findings; they must not be inferred solely from the patient's answers. The ten items are scored in a binary manner.
Are you patient?
You can describe your symptoms before your appointment. However, the full version requires an examination by a healthcare professional: do not attempt the sensory tests yourself to complete the score.
Terms of contract
The practitioner interviews the patient directly and completes the questionnaire. Symptoms may be gathered in preparation for a consultation, but the physical examination must still be carried out: a provisional score does not replace a complete DN4.
Score interpretationDN4
Each positive item is worth 1 point, each negative item 0 points. The total is scored out of 10.
Total score
First reading
0 to 3
Score below 4/10: below the screening threshold; does not rule out a neuropathic component.
4 to 10
Score of 4/10 or higher: result suggestive of a neuropathic component.
A total score of 4 or more out of 10 suggests neuropathic pain (sensitivity 82.9%, specificity 89.9%). This threshold only applies to the full 10-item DN4 questionnaire.
The score must be evaluated against the clinical history, pain distribution, and the search for an underlying explanatory lesion or disease. It does not measure the intensity of the pain. Pain can involve multiple mechanisms, and a positive score does not determine its cause.
Frequently asked questions
Sources and references
Didier Bouhassira, Nadine Attal and coworkers
Initial validation: Pain, 2005. Full version published by the HAS.
Questionnaires and associated scores
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