Cross-Cultural Adaptation and Psychometric Validation of the Chinese Version of the Douleur Neuropathique 4 Questionnaire in Patients with Knee Osteoarthritis

Background Knee osteoarthritis (KOA) patients frequently continue to experience persistent pain and functional limitations following total knee arthroplasty (TKA), posing substantial challenges for postoperative pain management. Accurate preoperative characterization of pain profiles is therefore essential for devising individualized treatment strategies. The Douleur Neuropathique 4 Questionnaire (DN4) is a concise, validated instrument for detecting neuropathic pain components and has demonstrated robust reliability and validity across diverse cultural settings. However, to date no culturally adapted Chinese version is available. This study aimed to translate and culturally adapt the DN4 into Chinese (DN4-CV) and to evaluate its psychometric properties in a cohort of Chinese KOA patients undergoing TKA. Methods Following established cross-cultural adaptation guidelines, the original DN4 was forward- and back-translated by bilingual experts, harmonized by a multidisciplinary panel, and piloted in 50 KOA patients. The finalized Chinese DN4 (DN4-CV) was administered to 335 KOA outpatients. Psychometric properties were assessed via internal consistency (Cronbach’s α), test–retest reliability (intraclass correlation coefficient, ICC), exploratory factor analysis (EFA) for structural validity, and receiver operating characteristic (ROC) analysis. The optimal cutoff score was determined by maximizing Youden’s index. Results The DN4-CV demonstrated good internal consistency (α = 0.805) and excellent test–retest reliability (ICC = 0.973). EFA identified two factors accounting for 56.32% of total variance. ROC analysis yielded an area under the curve of 0.979 (95% CI: 0.962–0.996). Using a cutoff score ≥ 4, sensitivity was 99.0%, specificity 96.4%, positive predictive value 97.5%, negative predictive value 98.5%, and overall accuracy 97.9%. Conclusions The DN4-CV is a reliable, valid, and highly accurate tool for screening neuropathic pain in KOA patients, supporting its clinical utility for early identification and individualized pain management.