Assessing Criterion Validity Of The Modified S-Lanss For The Detection Of Neuropathic Orofacial Pain Conditions

Abstract

Objective: To evaluate the accuracy of a questionnaire designed for the identification of intraoral pain with neuropathic characteristics in a clinical orofacial pain sample population. Methods: 136 participants with 4 orofacial pain diagnoses (temporomandibular disorders [TMD, n=41], acute dental pain [ADP, n=41], trigeminal neuralgia (TN, n=19), persistent dentoalveolar pain disorder [PDAP, n=14]) and a group of pain-free controls (n=21) completed the modified S-LANSS, an adaptation of the original questionnaire devised to detected patients suffering from intraoral pain with neuropathic characteristics. Psychometric properties (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) were calculated in two analyses with two different thresholds: 1) Detection of pain with neuropathic characteristics: PDAP + TN were considered positive, and TMD + ADP + controls were considered negative per gold standard (expert opinion). 2) Detection of PDAP: PDAP was considered positive and TMD + ADP were considered negative per gold standard. For both analyses, target values for adequate accuracy were defined as ≥80% for sensitivity and specificity. Results: For detection of orofacial pain with neuropathic characteristics (PDAP + TN), the modified S-LANSS presented with the most optimistic threshold sensitivity of 52% (95% CI: 34-69%), specificity of 70% (95% CI: 60-79%), PPV of 35% (95% CI: 22-51%), and NPV of 82% (95% CI: 72-89%). For detection of PDAP only, with the most optimistic threshold sensitivity was 64% (95% CI: 35-87%), specificity 63% (95% CI: 52-74%), PPV 23% (95% CI: 11-39%) and NPV 91% (95% CI: 81-97%). Conclusion: Based on a priori defined criteria, the modified S-LANSS did not show adequate accuracy to detect intraoral pain with neuropathic characteristics in a clinical orofacial pain population.