# Beyond the crisis: Tracking chronic neuropathic pain in sickle cell disease using Douleur Neuropathique 4 and PainDETECT questionnaires

## TL;DR

This study explores how chronic neuropathic pain is tracked in sickle cell disease patients using two questionnaires, revealing that it's more common than previously thought.

## Contribution

The study introduces a complementary strategy using two questionnaires to detect neuropathic pain in sickle cell disease patients.

## Key findings

- 29% of participants showed neuropathic pain according to the Douleur Neuropathique 4 questionnaire.
- PainDETECT identified 8.4% with neuropathic pain, rising to 22% when uncertain scores were included.
- Neuropathic pain was more common in older individuals and those with frequent pain episodes or opioid use.

## Abstract

Neuropathic pain represents a complex and often underdetected component of the pain spectrum in Sickle Cell Disease, particularly among individuals with chronic or treatment-resistant symptoms. Despite its clinical relevance, neuropathic pain is not routinely screened for in hematology practice, where pain is frequently attributed solely to vaso-occlusive mechanisms.

A cross-sectional study was conducted with 214 individuals diagnosed with Sickle Cell Disease at a hematology referral center in northeastern Brazil. Two validated instruments, Douleur Neuropathique 4 and PainDETECT were utilized to screen for neuropathic pain. Clinical and demographic data were collected, and the correlation between the instruments was assessed using Pearson’s coefficient.

The Douleur Neuropathique 4 tool identified neuropathic pain in 29 % of participants. PainDETECT indicated 8.4 %, which increased to 22 % when including uncertain-range scores. The correlation between the two tools was strong (r = 0.87). Neuropathic pain was more prevalent among older individuals, those who reported recurrent painful episodes in the past year (p-value <0.001), and those with recent opioid use (p-value = 0.042). Sensory descriptors such as tingling, numbness, and electric shock sensations were commonly reported.

The combined use of Douleur Neuropathique 4 and PainDETECT, both of which are quick and simple to administer, proved to be a complementary strategy for identifying neuropathic pain, with each instrument capturing distinct features. Incorporating this approach into hematology care may facilitate the detection of pain profiles beyond vaso-occlusion and support more individualized treatment decisions.