Screen for neuropathic pain. Free to use.
DN4 (Douleur Neuropathique 4 questions) is a validated clinical instrument used to assess screen for neuropathic pain. The instrument contains 10 items.
Source / attribution: Bouhassira D et al. Pain. 2005;114(1-2):29-36.
The instrument's primary construct — screen for neuropathic pain — is operationalized through a fixed set of items, each with a defined response format. This standardisation is what allows DN4 scores to be compared meaningfully across clinicians, sites, and studies.
Like all screening or assessment instruments, DN4 is a structured aid — not a diagnostic test in isolation. Results should be interpreted alongside history, examination, and clinical context. Where a score crosses an actionable threshold, the next step is typically a more detailed clinical evaluation rather than a definitive diagnosis.
Answer all 10 items below to see your DN4 score and interpretation.
All scoring runs in your browser. No data is sent anywhere — close the tab and the answers are gone.
DN4 uses weighted summation: each item carries a fixed weight that is added when the response indicates a positive finding.
Scoring notes: Items 8–10 require clinical examination.
The cutoffs below are drawn from the published validation literature. Always interpret in clinical context.
| Score range | Band | Interpretation |
|---|---|---|
| 0–3 | Nociceptive mechanism likely | DN4 < 4 — neuropathic mechanism unlikely. |
| 4–10 | Neuropathic mechanism likely | DN4 ≥ 4 — sensitivity 83%, specificity 90% for neuropathic pain. |
This is an illustrative walkthrough, not a real patient. Follow the same four steps with your own answers — or use the live calculator at the top of this page.
Mark each item Yes or No. Each "Yes" adds the item's weight; each "No" adds 0. The example below uses illustrative answers.
| # | Item | Example response | Score |
|---|---|---|---|
| 1 | Pain has the following characteristic: burning? | Yes | 1 |
| 2 | Painful cold? | Yes | 1 |
| 3 | Electric shocks? | Yes | 1 |
| 4 | Associated with tingling? | Yes | 1 |
| 5 | Associated with pins and needles? | Yes | 1 |
| 6 | Associated with numbness? | No | 0 |
| 7 | Associated with itching? | Yes | 1 |
| 8 | On exam: hypoesthesia to touch in the painful area? | No | 0 |
| 9 | On exam: hypoesthesia to pin-prick in the painful area? | Yes | 1 |
| 10 | On exam: brushing the painful area increases or evokes pain? | No | 0 |
Add the weights from the items where you marked "Yes" (skip the "No" answers — they contribute 0).
1 + 1 + 1 + 1 + 1 + 0 + 1 + 0 + 1 + 0 = 7
Find the row in the interpretation table whose range contains your total:
Total = 7 falls between 4 and 10 → Neuropathic mechanism likely
Neuropathic mechanism likely. DN4 ≥ 4 — sensitivity 83%, specificity 90% for neuropathic pain.
A score is one input alongside history and examination. DN4 supports clinical judgment — it does not replace it.
If DN4 doesn't fit your context, related instruments in pain include:
| Scale | Measures | Items | Time |
|---|---|---|---|
| NRS Pain | Self-reported pain intensity | 1 | — |
| PEG | Brief pain-impact assessment in primary care | 3 | — |
| LANSS | Screen for neuropathic component of pain | 7 | — |
| PHQ-9 | Severity of depression | 9 | ≈ 3 minutes |
| GAD-7 | Severity of generalized anxiety | 7 | ≈ 2 minutes |
| AUDIT | 10-item WHO screening tool for hazardous alcohol consumption and dependence. | 10 | ≈ 3 min |
| CHA2DS2-VASc | Annual stroke risk in non-valvular atrial fibrillation | 8 | — |
| Glasgow Coma Scale | Level of consciousness after head injury | 3 | — |
DN4 (Douleur Neuropathique 4 questions) is a validated instrument that assesses screen for neuropathic pain. It is designed for clinicians, medical students, evidence-synthesis researchers. The 10 items are combined to produce a total score.
DN4 contains 10 items. Item scores are combined with weighted scoring to produce the total. Scores run from 0 to 10, grouped into 2 interpretation bands from ‘Nociceptive mechanism likely’ up to ‘Neuropathic mechanism likely’.
On the DN4 (total score 0–10), scores of 4–10 fall in the ‘Neuropathic mechanism likely’ band — interpreted as: DN4 ≥ 4 — sensitivity 83%, specificity 90% for neuropathic pain. The full ladder is: 0–3 — Nociceptive mechanism likely: DN4 < 4 — neuropathic mechanism unlikely.; 4–10 — Neuropathic mechanism likely: DN4 ≥ 4 — sensitivity 83%, specificity 90% for neuropathic pain. A higher score reflects a more severe presentation, and crossing a cutoff is a prompt to step up assessment or care — but these bands are screening thresholds, not diagnoses.
Scores of 0–3 fall in the ‘Nociceptive mechanism likely’ band: DN4 < 4 — neuropathic mechanism unlikely. A low score is reassuring but does not by itself rule out the underlying condition — if symptoms or clinical suspicion persist, reassess over time or use a complementary evaluation rather than relying on the number alone.
Yes — DN4 is in the public domain and free for clinical, educational, and research use without permission. You can use this calculator and the scale itself freely; if you publish results or reproduce the scale, cite the original source paper.
Bouhassira D et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114(1-2):29-36. This is the original publication for the DN4 — the reference to cite when reporting results.
No. DN4 is a structured assessment aid, not a diagnostic test. Its proper role is clinical assessment of screen for neuropathic pain — it standardizes assessment and flags who needs closer evaluation, but the result must be weighed alongside history, examination, and clinical context. When a score conflicts with your clinical impression, clinical judgment takes precedence; treatment decisions should never rest on a screening score alone.
DN4 is supported by the following peer-reviewed sources: