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.

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What did Part 1 do?

Prospectively evaluated symptoms/signs to build a standardized tool for pain subtypes.

What did Part 2 validate?

Distinction between radicular and axial chronic LBP using StEP in an independent group.

Eligibility basics?

Pain ≥3 months, average intensity ≥6/10, age ≥18, consent.

Best single discriminator?

Pinprick: 95% sensitive and 93% specific for neuropathic vs non-neuropathic pain.

What comparator screening tool was used?

DN4 neuropathic pain questionnaire.

How is pain intensity rated?

11-point NRS from 0 (no pain) to 10 (maximum).

Interview/exam breadth?

16 interview questions (46 items) and 23 bedside tests (39 items).

Straight-leg raise role?

Positive SLR indicated radicular LBP with high specificity among neuropathic cases.

Combined-test PPV for radicular LBP?

Empirical PPV 100% (95% CI 59–100%) for radicular LBP with the three-sign combination.

Clinical purpose of StEP?

Characterize sensory pain subtypes to support mechanism-minded assessment beyond global pain scores.