Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs

In recent years tools designed to evaluate and diagnose neuropathic pain have been developed. Whilst most of these tools comprise both patient self-report items and physical assessment of sensory features, the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) (Bennett et at 2005) allows for patient self-completion. The S-LANSS was developed from the original LANSS tool (Bennett 2001) and was designed to be capable of identifying pain of predominantly neuropathic origin on the basis of the patient's current symptoms and signs (Bennett et al 2005). It is free and available from the original paper. Instructions to the client and scoring: The questionnaire takes only 5-10 minutes to complete and score, and requires no special training to administer. It comprises seven items consisting of five symptom items and two self-examination items. The symptom items include questions about pins and needles, skin colour changes, increased skin sensitivity, I electric shock' type pain, and 'burning pain'. The two self-examination items include allodynia and numbness. A score of 12 or greater identifies patients with pain of a predominantly neuropathic origin (Bennett et al 2005). Validity, reliability and sensitivity to change: In 200 patients with chronic pain and attending a tertiary pain referral centre, the S-LANSS was demonstrated to be 74% (95% CI 65% to 83%) sensitive and 76% (95% CI 68% to 85%) specific in identifying neuropathic pain when subjects completed the questionnaire unaided, and 80% sensitive and 80% specific when completed in an interview format (Bennett et al 2005). In this study, the reference or gold standard used for comparison was detailed expert clinical examination and assessment. Sensitivity (57%; 95% CI 46% to 69%) and specificity (69%; 95% CI 61% to 77%) of the S-LANSS have been shown to be lower when used in a general community population (Weingarten et al 2007). Internal consistency (Cronbach's alpha = 0.76 to 0.81) has been demonstrated to be satisfactory (Bennett et al 2005). It is claimed that the S-LANSS has construct validity due to the association of individual item scores to the total score (Bennett et al 2005). There have been no studies investigating test retest reliability. The S-LANSS is designed to be a screening tool and as such its sensitivity to change has not been investigated. Nevertheless the original LANSS tool has shown sensitivity to treatment effects (Khedr et al 2005) but this is an area that requires more investigation.