DN4 Questionnaire for Neuropathic Pain
Douleur Neuropathique en 4 Questions (DN4). Distinguishes neuropathic pain from nociceptive pain. Score ≥4/10 is diagnostic of neuropathic pain component with 80% sensitivity and 92% specificity.
Score interpretation
→ DN4 ≥4: Likely neuropathic pain component. First-line: duloxetine 60 mg or pregabalin 150–600 mg/day or amitriptyline 10–75 mg nocte. Topical lidocaine or capsaicin for localised neuropathic pain. Second-line: strong opioid (tramadol) or combination. Neurology/pain clinic referral if refractory.
→ DN4 <4: Neuropathic pain unlikely. Consider nociceptive or mixed pain mechanisms. Standard analgesia (paracetamol, NSAIDs, weak opioids). Reassess if symptoms evolve; consider alternative causes of pain.
Interpretation bands for the DN4 Score. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Numeric Rating Scale (NRS) for Pain · Pain Assessment
- Critical-Care Pain Observation Tool (CPOT) · Pain Assessment
- Behavioral Pain Scale (BPS) for Ventilated Patients · Pain Assessment
- Pain Assessment in Advanced Dementia Scale (PAINAD) · Pain Assessment
- Abbey Pain Scale for Dementia · Pain Assessment
- CHEOPS — Children's Hospital of Eastern Ontario Pain Scale · Pain Assessment
- Pregabalin · Anticonvulsant / Neuropathic Pain
- Pregabalin (Burns — Neuropathic Pain) · Anticonvulsant / Neuropathic Analgesic
- Pregabalin · Anticonvulsant / Neuropathic Analgesic / Anxiolytic
- Amitriptyline (Neuropathic Pain / Migraine) · Tricyclic Antidepressant / Neuropathic Pain Agent
- Gabapentin · Alpha-2-Delta Ligand — Neuropathic Pain / Epilepsy Adjunct
- Gabapentin · Anticonvulsant / Neuropathic Pain
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.