Validity and reliability of the Indonesian version of the Douleur Neuropathique 4 for neuropathic pain
DOI:
https://doi.org/10.13181/mji.oa.257725Keywords:
diagnosis, neuropathic pain, questionnaires, reliability and validityAbstract
BACKGROUND The Douleur Neuropathique 4 (DN4) is a widely used questionnaire for assessing neuropathic pain, demonstrating good sensitivity and specificity across various languages. Originally developed in France, cultural and linguistic differences necessitate its translation, validation, and reliability testing before use in Indonesia. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Indonesian version of the DN4 questionnaire (DN4-Ina) for use in clinical and research settings.
METHODS Translation and cross-cultural adaptation were conducted following World Health Organization guidelines in Indonesian. A cross-sectional study was conducted in the Neurology Clinic, Cipto Mangunkusumo Hospital, to assess the validity and reliability of the DN4-Ina. The study subjects were selected through consecutive sampling of adult patients with chronic pain visiting the clinic from June to December 2023. Validity and reliability were assessed using SPSS software version 25. Validity testing utilized adjusted item-total correlation analysis, while reliability testing was evaluated using the test-retest method, intraclass correlation coefficient (ICC), and Cronbach’s alpha for internal consistency.
RESULTS Of 40 participants, 65% were female, with a mean age of 51.85 (13–92) years, moderate pain intensity (mean numeric rating scale of 4.25 [2.99]), and pain duration of 7.95 (4.41) months. All DN4-Ina questions showed a correlation coefficient (r) greater than the table’s value (0.312). The reliability test showed an ICC of 0.99 and a Cronbach’s alpha of 0.746.
CONCLUSIONS The DN4-Ina score is a valid and reliable questionnaire for assessing neuropathic pain in the Indonesian population.
Downloads
References
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82. https://doi.org/10.1097/j.pain.0000000000001939
Mathieson S, Maher CG, Terwee CB, Folly de Campos T, Lin CW. Neuropathic pain screening questionnaires have limited measurement properties. A systematic review. J Clin Epidemiol. 2015;68(8):957−66. https://doi.org/10.1016/j.jclinepi.2015.03.010
Meacham K, Shepherd A, Mohapatra DP, Haroutounian S. Neuropathic pain: central vs. peripheral mechanisms. Curr Pain Headache Rep. 2017;21(6):28. https://doi.org/10.1007/s11916-017-0629-5
Purba JS, Aninditha T. [Neuropathic pain]. In: Aninditha T, Harris S, Wiratman W, editors. [Textbook of neurology, second edition]. Jakarta: Department of Neurology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital; 2022. Indonesian.
Aho T, Mustonen L, Kalso E, Harno H. Douleur Neuropathique 4 (DN4) stratifies possible and definite neuropathic pain after surgical peripheral nerve lesion. Eur J Pain. 2020;24(2):413-22. https://doi.org/10.1002/ejp.1498
Taherdoost H. Validity and reliability of the research instrument; how to test the validation of a questionnaire/survey in a research. Int J Acad Res Manag. 2016;5(3):28-36. https://doi.org/10.2139/ssrn.3205040
Finnerup NB, Kuner R, Jensen TS. Neuropathic pain: from mechanisms to treatment. Physiol Rev. 2021;101(1):259-301. https://doi.org/10.1152/physrev.00045.2019
Cámara RJ, Gharbo RK, Egloff N. Age and gender as factors of pressure sensitivity of pain-free persons: are they meaningful? J Pain Res. 2020;13:1849-59. https://doi.org/10.2147/JPR.S248664
Parenteau CS, Lau EC, Campbell IC, Courtney A. Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data. Sci Rep. 2021;11(1):5389. https://doi.org/10.1038/s41598-021-84724-6
Krkoška P, Rajdová A, Bednařík J, Fish L, Adamová B, Vlčková E. Validation of the Czech language version of the DN4 and PainDetect questionnaire for diagnosing neuropathic pain. Cesk Slov Neurol N. 2022;85(1):59-69. https://doi.org/10.48095/cccsnn202259
Gomez MaF, Gomez MF, Gomez MH, Que JC, Rosales RL. painDETECT questionnaire Filipino version: transcultural adaptation and validation in two widely spoken regional languages (Tagalog and Cebuano). Neurol Asia. 2019;24(1):21-30.
Widyadharma IP. Realibility of the leeds assessment of neuropathic symptoms and signs (LANSS) scale (Indonesian version) in type II diabetic patients. CPD Neuro-diabetes; 2015; Yogyakarta.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Henry Riyanto Sofyan, Chandra Hartono, Irma Savitri, Raymond Aris Nimrod Alvonsius, Manfaluthy Hakim, Tiara Aninditha

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.



