StEP pain-subtype assessment
A structured interview-plus-exam tool (StEP) was developed and validated to separate neuropathic/radicular from non-neuropathic axial low-back pain.
Source
A novel tool for the assessment of pain: validation in low back pain
Study at a glance
- Design
- Cross-sectional — Two-part tool development then independent clinic validation of StEP
- N
- N=137 · Part 2 validation after exclusions; Part 1 development n=187
- Population
- Specialist clinic patients with chronic low back pain
- Outcome
- Discrimination of radicular vs axial / neuropathic vs non-neuropathic LBP (StEP signs)
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StEP pain-subtype assessment
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Pinprick sensitivity 95% (95% CI 89–97%) and specificity 93% (95% CI 83–98%).
Pinprick was the most sensitive (95%; 95% CI 89%–97%) and most specific (93%; 95% CI 83%–98%) single test to distinguish between neuropathic and non-neuropathic pain.
What did Part 1 do?
In Part 1, we prospectively evaluated a comprehensive range of pain-related symptoms and signs in order to develop a standardized clinical tool for the differentiation of pain subtypes.
What they did
Part 1 mapped symptoms/signs across pain subtypes to build StEP; Part 2 applied it in an independent chronic LBP cohort to distinguish radicular vs axial pain, benchmarking against clinical classification.
What they found
Pinprick response was highly sensitive (95%) and specific (93%) for neuropathic vs non-neuropathic pain; combined signs gave strong predictive values for radicular LBP.
The limits
What it doesn't show
StEP is not a standalone imaging replacement and was validated in specialist clinic populations.
Key terms
- StEP
- Standardized Evaluation of Pain structured interview and bedside exam.
- Radicular pain
- Pain from nerve-root involvement, often leg-radiating.
- Axial LBP
- Back-predominant pain without clear radicular pattern.
- Neuropathic pain
- Pain from lesion/disease of the somatosensory system.
- Pinprick testing
- Bedside sensory test that best separated neuropathic from non-neuropathic pain here.
- DN4
- Neuropathic pain screening questionnaire compared with StEP.
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StEP is primarily a:
Common questions
What is StEP?
A standardized symptom interview plus physical tests for pain subtypes.
Who was studied?
Adults with chronic pain ≥3 months and average intensity ≥6/10.
Best single test?
Pinprick: 95% sensitive and 93% specific for neuropathic vs non-neuropathic pain.
Part 2 purpose?
Validate distinguishing radicular vs axial chronic LBP.
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