Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus.
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Cites background from "Value of quantitative sensory testi..."
...Quantitative sensory testing has been used for decades in a variety of research settings, often for the purpose of diagnosing and monitoring sensory neuropathies and pain disorders, as well as for the investigation of pain mechanisms, the characterization of somatosensory profiles in various pain disorders, and the elucidation of individual differences in pain sensitivity and pain modulation.(4,15,15,62,161,190,203,204) Quantita-...
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...clinical deterioration (eg, the development of foot ulcers in patients with diabetes) or the worsening of neuropathy.(15) To date, relatively few phase 2 and 3 analgesic RCTs have used baseline phenotyping by QST to predict treatment response....
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...Recent reviews have called for increased application and study of such brief, bedside QST protocols, which do not require specialized equipment, and which may be feasible additions to large multicenter trials.(15,27,62) In addition, trial-to-trial variability of...
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References
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"Value of quantitative sensory testi..." refers background in this paper
...The diagnosis of neuropathic pain is based on the combination of clinical symptoms (pain and positive sensory phenomena) and signs (sensory deficits and evoked pains) [105]....
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"Value of quantitative sensory testi..." refers background or methods in this paper
...Description In the last 2 decades, several groups have published normative data sets for thermal threshold detection and pain threshold testing, with various algorithms used [22,29,76,93,94,109,113,114]....
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...The instructions should be concise and to the point, as well as clear and short in terms of wording so subjects can easily remember the instructions for the duration of the QST [93,94]....
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...For subjects, a set of training stimuli are generally used in an unaffected area before testing on the same day (clinical use) or, if possible, 1 to 2 days before (research use) in order to familiarize the subject with the stimulus administration and response procedures [93,94,109]....
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...Most commonly, computerized systems are used to deliver thermal stimuli, while handheld devices are generally used for application of mechanical and vibratory stimuli [10,21,94] (Appendix A)....
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...QST instructions are generally prepared in standardized written form and presented verbally; they are written in such a way as to avoid influencing subjects’ expectations—for example, by not telling them what they should or should not feel [93,94]....
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926 citations
"Value of quantitative sensory testi..." refers background or methods in this paper
...QST has largely contributed to characterize allodynia and hyperalgesia to brush and to static mechanical or thermal stimuli in neuropathic syndromes, particularly postherpetic neuralgia, painful polyneuropathies, and central pain [11,25,28,39,56,77, 84,88,95], as well as in other pain disorders, such as headache, fibromyalgia, osteoarthritis, migraine, and orofacial pain [9,14,18,19,40,63,66,101,103,108] (Table 5)....
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...This may contribute to characterize various painful conditions; for Table 1 Differences and similarities between quantitative sensory testing and conventional electro Characteristic Electrophysiological techniques: NCS and SEP [24,31] Type of information obtained Functional status of large myelinated sensory fiber system terms of conduction, velocity and size of the amplitude, refl status of myelination and fiber loss Localization along neuroaxis, of entire length for SEP and P NCS No ability to assess positive phenomena Do not assess small fibers and spinothalamic tract Nature of the subject participation in the testing Does not require responses from the subject No active cooperation required Need for training Training required for investigators but not for subjects Normative data Published normative data and available data from most e physiological laboratories NCS, nerve conduction studies; SEP, somatosensory-evoked potential. example, brush-induced allodynia is frequent in traumatic nerve lesions or postherpetic neuralgia [77,95], mechanical static hyperalgesia is common in complex regional pain syndrome, fibromyalgia, or osteoarthritis [63,72,77,102], and hyperalgesia to cold stimuli is a hallmark of oxaliplatin-induced neuropathy [7,77]....
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...Painful and painless neuropathic patients [ NP and NNP in patients [52] Suggestive of mechanisms [18,19,26,39] Longitudinal studies...
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...One retrospective study assessed the relationship between individual outcomes of bedside sensory examination and thermal and Table 4 Clinical utility of QST to assess sensory deficits in research studies and consensus recomm Deficit Evidence from research studies Diabetic neuropathy (thermal, mechanical, vibration) Documentation of sensory deficits Cold deficits: 27–98% sensitivitya [21] Warm deficits: 22–88% sensitivitya [21] Vibration: 58–84% sensitivity, 51–86% specificity [ Early impairment of thermal testing [74,119] Correlation with the clinical staging of neurop [29,74,88,119] Moderate correlation with NCS [19,42,61,78,92] Longitudinal studies Monitoring of sensory function [30,37,64,98,120] Response to disease modifying agentsb [3,4,120] Prediction of clinical deterioration [38,44] Small fiber neuropathies (thermal testing) Sensitivity 36–100% but criteria of small fiber neuropathy var [20,27,117] to skin punch biopsy (62–88%)c [27] Diagnostic value Lower diagnostic efficiency (47...
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...Correlation with the clinical staging of neurop [29,74,88,119] Moderate correlation with NCS [19,42,61,78,92] Longitudinal studies Monitoring of sensory function [30,37,64,98,120] Response to disease modifying agents [3,4,120] Prediction of clinical deterioration [38,44]...
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909 citations
"Value of quantitative sensory testi..." refers background or methods in this paper
...Several studies have reported that the presence and severity of allodynia to brush could discriminate patients with a painful neurological lesion from those without pain [26,28,39,91] or with nonneuropathic pain [52]....
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...Response to analgesic treatments [6,52] Prediction of the response to therapy [6,17 Prediction of postsurgical pain [15,49,79]...
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...This is despite the existence of published guidelines and recommendations for the diagnosis and follow-up of sensory abnormalities in diabetic neuropathy using QST [23,59,99] and for the assessment of neuropathic pain [25,52]....
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...In particular, mechanical and thermal QST has been extensively used in double-blind pharmacological clinical trials conducted by single centers (see [52] for references) and has been able to reveal antihyperalgesic properties of various drugs (eg, iv sodium channel blockers, NMDA antagonists)....
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...QST has sometimes revealed modality-specific effects on distinct subtypes of hyperalgesia (ie, thermal vs mechanical allodynia, predominant effects on enhanced temporal summation) [52]....
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