Reliability and validity of the Japanese translation of the DN4 Diagnostic Questionnaire in patients with neuropathic pain.

BACKGROUND: The Douleur Neuropathique 4 questionnaire (DN4) is a simple and objective tool developed by the French Neuropathic Pain Group to screen for neuropathic pain. METHODS: This prospective observational study was undertaken in three hospitals to assess the validity of a Japanese translation of the DN4. We first translated the DN4 into Japanese using a forward-backward method. Pain specialists then examined patients independently and diagnosed them with neuropathic or non-neuropathic pain, according to the International Association for the Study of Pain definitions. The Japanese version of the DN4 questionnaire was then given to each patient. RESULTS: Of 187 patients that met our inclusion criteria, 100 and 87 were diagnosed with neuropathic and non-neuropathic pain, respectively. The test-retest intra-class correlation coefficient (95% confidence interval) was 0.827 (0.769-0.870). Among patients with identical diagnoses of neuropathic or non-neuropathic pain, receiver-operating characteristic curve analysis revealed an area under the curve of 0.89. A cut-off point of equal or greater than 4 resulted in a sensitivity of 71% and specificity of 92%. CONCLUSION: The Japanese version of the DN4 was found to be a helpful tool for discriminating between neuropathic and non-neuropathic pain.

Spinal cord stimulation for treatment of leg pain associated with lumbar spinal stenosis.

OBJECTIVE: Spinal cord stimulation (SCS) is expected to have analgesic effects in patients with neuropathic pain, ischemic pain, or mixed pain. The type of leg pain caused by lumbar spinal stenosis (LSS) is considered as mixed pain, which is expected to respond to SCS. However, there is no established view on the usefulness of SCS in the management of this type of pain. Therefore, we aimed at evaluating the efficacy of SCS against leg pain associated with LSS. MATERIALS AND METHODS: Data were collected retrospectively for the period from January 2003 to December 2011 from 91 patients with LSS-associated leg pain enrolled to the SCS trial. SCS implantation was performed in patients who responded to the trial and desired to receive this therapy. RESULTS: The response rate (percentage of patients showing 50% or greater alleviation of pain) in the trial was 65% (59/91 patients). SCS implantation was performed on 41 patients. The percentage of patients who showed a good response (definition is SCS continued for one year or longer after implantation) was 95% (39/41). CONCLUSION: SCS seemed to be effective against leg pain associated with LSS. Thus, SCS should be actively adopted in indicated patients as a method of treatment intermediate between conservative therapy and surgical therapy.

[Successful management with remifentanil of tracheal stent insertion keeping spontaneous breathing in a patient with severe respiratory insufficiency].

We report that spontaneous breathing under total intravenous anesthesia by 0.1 microg x kg(-1) x hr(-1) of remifentanil and 3 mg x kg(-1) x hr(-1) of propoforl can be maintained during the surgery for tracheobronchial stent insertion in a man with severe trachea stenosis. Remifentanil is an ultra-short acting narcotic, and is excellent for relieving pain maintaining stable hemodynamics. As this drug is used at a low dose, it is suitable for this case which requires a short time of operation, minimally invasive surgery, prevention of moving, and the spontaneous breathing. We could achieve steady respiratory and hemodynamic control.