Improving Neuropathic Pain Assessment in Regional Languages: Validation of the Kannada Douleur Neuropathique 4

Abstract

A BSTRACT Neuropathic pain (NP) is a long-lasting condition caused by damage or disease affecting the somatosensory system. Although the Douleur Neuropathique 4 (DN4) is a frequently employed diagnostic tool, a validated Kannada version has yet to be developed. This study intended to validate the Kannada version of the DN4 (KN-DN4) to accurately identify NP in Kannada speakers. This cross-sectional validation study involved 290 participants (155 with NPP and 135 with non-neuropathic pain). The KN-DN4 underwent linguistic adaptation, cognitive debriefing, and expert face validation. Two trained raters independently administered the questionnaire, and reliability, validity, and factorial structure were evaluated. The KN-DN4 exhibited strong internal consistency with a Cronbach’s α of 0.85, along with outstanding inter-rater reliability (ICC = 0.91) and test–retest reliability (ICC = 0.89). Patients with NP had considerably higher scores than those without (5.9 ± 1.3 vs. 1.7 ± 1.1, P < 0.001), indicating construct validity. Receiver Operating Characteristic analysis demonstrated high diagnostic accuracy (Area under the curve [AUC] =0.92), with 85.8% sensitivity and 81.5% specificity. Convergent validity was supported by correlations with Visual Analog Scale ( r = 0.62) and SF-MPQ sensory scores ( r = 0.68). Factor analysis identified a two-factor solution reflecting symptoms and clinical signs. The KN-DN4 has demonstrated strong reliability and validity for diagnosing NP among Kannada-speaking patients, making it appropriate for application in both clinical practice and research contexts.