Journal ArticleDOI
Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values
Roman Rolke,Ralf Baron,Christoph Maier,Thomas R. Tölle,Rolf-Detlef Treede,Antje Beyer,Andreas Binder,Niels Birbaumer,Frank Birklein,I. C. Bötefür,S. Braune,Herta Flor,Volker Huge,R. Klug,G. B. Landwehrmeyer,Walter Magerl,Christian Maihöfner,C. Rolko,C. Schaub,Andrea Scherens,Till Sprenger,Michael Valet,B. Wasserka +22 more
TLDR
Application of this standardized QST protocol in patients and human surrogate models will allow to infer underlying mechanisms from somatosensory phenotypes as well as judge plus or minus signs in patients.Abstract:
The nationwide multicenter trials of the German Research Network on Neuropathic Pain (DFNS) aim to characterize the somatosensory phenotype of patients with neuropathic pain. For this purpose, we have implemented a standardized quantitative sensory testing (QST) protocol giving a complete profile for one region within 30 min. To judge plus or minus signs in patients we have now established age- and gender-matched absolute and relative QST reference values from 180 healthy subjects, assessed bilaterally over face, hand and foot. We determined thermal detection and pain thresholds including a test for paradoxical heat sensations, mechanical detection thresholds to von Frey filaments and a 64 Hz tuning fork, mechanical pain thresholds to pinprick stimuli and blunt pressure, stimulus/response-functions for pinprick and dynamic mechanical allodynia, and pain summation (wind-up ratio). QST parameters were region specific and age dependent. Pain thresholds were significantly lower in women than men. Detection thresholds were generally independent of gender. Reference data were normalized to the specific group means and variances (region, age, gender) by calculating z-scores. Due to confidence limits close to the respective limits of the possible data range, heat hypoalgesia, cold hypoalgesia, and mechanical hyperesthesia can hardly be diagnosed. Nevertheless, these parameters can be used for group comparisons. Sensitivity is enhanced by side-to-side comparisons by a factor ranging from 1.1 to 2.5. Relative comparisons across body regions do not offer advantages over absolute reference values. Application of this standardized QST protocol in patients and human surrogate models will allow to infer underlying mechanisms from somatosensory phenotypes.read more
Citations
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Journal ArticleDOI
Central sensitization: implications for the diagnosis and treatment of pain.
TL;DR: Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity.
Journal ArticleDOI
Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment
TL;DR: A better understanding of neuropathic pain and of the translation of pathophysiological mechanisms into sensory signs will lead to a more effective and specific mechanism-based treatment approach.
Journal ArticleDOI
Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update
Robert H. Dworkin,Alec B. O'Connor,Joseph Audette,Ralf Baron,Geoffrey K. Gourlay,Maija Haanpää,Joel L. Kent,Elliot J. Krane,Elliot J. Krane,Alyssa Lebel,Robert M. Levy,Sean Mackey,John M. Mayer,Christine Miaskowski,Srinivasa N. Raja,Andrew S.C. Rice,Kenneth E. Schmader,Brett R. Stacey,Steven P. Stanos,Rolf-Detlef Treede,Dennis C. Turk,Gary A. Walco,Christopher D. Wells +22 more
TL;DR: A review of the evidence-based guidelines for the pharmacological treatment of neuropathic pain can be found in this article, where botulinum toxin, high-concentration capsaicin patch, lacosamide, selective serotonin reuptake inhibitors, and combination therapies are presented.
Journal ArticleDOI
NeuPSIG guidelines on neuropathic pain assessment
Maija Haanpää,Nadine Attal,Miroslav Backonja,Ralf Baron,Michael I. Bennett,Didier Bouhassira,Giorgio Cruccu,Per Hansson,Jennifer A. Haythornthwaite,Gian Domenico Iannetti,Troels S. Jensen,Timo Kauppila,Turo Nurmikko,Andew S C Rice,Michael C. Rowbotham,Jordi Serra,Claudia Sommer,Blair H. Smith,Rolf-Detlef Treede +18 more
TL;DR: Screening questionnaires are suitable for identifying potential patients with neuropathic pain, but further validation of them is needed for epidemiological purposes and quantitative sensory testing is recommended for selected cases in clinic, including the diagnosis of small fiber neuropathies and for research purposes.
Journal ArticleDOI
Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes
Christoph Maier,R. Baron,Thomas R. Tölle,Andreas Binder,Niels Birbaumer,Frank Birklein,Janne Gierthmühlen,Herta Flor,Christian Geber,Volker Huge,Elena K. Krumova,G. B. Landwehrmeyer,Walter Magerl,Christian Maihöfner,Helmut Richter,Roman Rolke,Andrea Scherens,A. Schwarz,Claudia Sommer,V. Tronnier,Nurcan Üçeyler,Michael Valet,Gunnar Wasner,D.-R. Treede +23 more
TL;DR: Somatosensory profiles with different combinations of loss and gain are shared across the major neuropathic pain syndromes, including thermal and mechanical hyperalgesias, which were most frequent in complex regional pain syndrome and peripheral nerve injury, allodynia in postherpetic neuralgia.
References
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Journal ArticleDOI
Quantitative sensory testing: a comprehensive protocol for clinical trials
Roman Rolke,Walter Magerl,K. Andrews Campbell,C. Schalber,S. Caspari,Frank Birklein,Rolf-Detlef Treede +6 more
TL;DR: A comprehensive QST protocol is compiled using well established tests for nearly all aspects of somatosensation to test for patterns of sensory loss or gain, and to assess both cutaneous and deep pain sensitivity.
Journal ArticleDOI
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Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes
Christoph Maier,R. Baron,Thomas R. Tölle,Andreas Binder,Niels Birbaumer,Frank Birklein,Janne Gierthmühlen,Herta Flor,Christian Geber,Volker Huge,Elena K. Krumova,G. B. Landwehrmeyer,Walter Magerl,Christian Maihöfner,Helmut Richter,Roman Rolke,Andrea Scherens,A. Schwarz,Claudia Sommer,V. Tronnier,Nurcan Üçeyler,Michael Valet,Gunnar Wasner,D.-R. Treede +23 more