The NTSS-6 SA has been translated into many different languages. It is designed to assess the severity of peripheral neuropathy symptoms. The objective of this study was to produce translations that are conceptually equivalent to the original and to other language versions, ensuring the relevance of the translations within the target cultures. A standard methodology was employed: 2 forward translations, a reconciliation of the forward translations, 2 back translations, back translation review; or an in-country review; linguistic validation interviews with 5 patients with diabetic peripheral neuropathy in each country, and 2 proofreadings. Numerous cultural and linguistic issues became apparent throughout the translation process, including the following: - Many different pain types are described (e.g. stabbing, shooting, electric-shock like, boring, aching) which were particularly difficult as this vocabulary was unavailable in some languages. A decision was made to assign the pain types into two groups; firstly dull, aching pains, and secondly sharper, stabbing pains. These could then be more easily conveyed and translated. - For many countries, there was no direct translation for ‘pins and needles'. If the country had no idiomatic description of this, ‘feeling as if ants crawl on the skin' was used. - Some items ask about ‘feet'; many of the countries involved have no specific word for ‘feet', so ‘from ankle to toes' was translated. - Some languages were unable to convey ‘asleep feeling' in a limb; this wording was therefore converted to ‘numbness'. The NTSS-6 SA has been translated and linguistically validated using a rigorous translation process. A number of cultural and linguistic issues became apparent and were resolved. The measure is now appropriate for use in multinational trials.