Journal ArticleDOI
Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus.
Miroslav Backonja,Nadine Attal,Ralf Baron,Didier Bouhassira,Mark Drangholt,Peter J. Dyck,Robert R. Edwards,Roy Freeman,Richard H. Gracely,Maija H. Haanpaa,Per Hansson,Samar Hatem,Elena K. Krumova,Troels S. Jensen,Christoph Maier,Gérard Mick,Andrew S.C. Rice,Roman Rolke,Rolf-Detlef Treede,Jordi Serra,Thomas R Toelle,Valeri Tugnoli,David Walk,Mark S. Walalce,Mark A. Ware,David Yarnitsky,Dan Ziegler +26 more
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TLDR
Quantitative sensory testing (QST) is a psychophysical method used to quantify somatosensory function in response to controlled stimuli in healthy subjects and patients as discussed by the authors, which has not gained a large acceptance among clinicians for many reasons, and in significant part because of the lack of information about standards for performing QST, its potential utility and interpretation of results.Abstract:
Quantitative sensory testing (QST) is a psychophysical method used to quantify somatosensory function in response to controlled stimuli in healthy subjects and patients. Although QST shares similarities with the quantitative assessment of hearing or vision, which is extensively used in clinical practice and research, it has not gained a large acceptance among clinicians for many reasons, and in significant part because of the lack of information about standards for performing QST, its potential utility, and interpretation of results. A consensus meeting was convened by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) to formulate recommendations for conducting QST in clinical practice and research. Research studies have confirmed the utility of QST for the assessment and monitoring of somatosensory deficits, particularly in diabetic and small fiber neuropathies; the assessment of evoked pains (mechanical and thermal allodynia or hyperalgesia); and the diagnosis of sensory neuropathies. Promising applications include the assessment of evoked pains in large-scale clinical trials and the study of conditioned pain modulation. In clinical practice, we recommend the use QST for screening for small and large fiber neuropathies; monitoring of somatosensory deficits; and monitoring of evoked pains, allodynia, and hyperalgesia. QST is not recommended as a stand-alone test for the diagnosis of neuropathic pain. For the conduct of QST in healthy subjects and in patients, we recommend use of predefined standardized stimuli and instructions, validated algorithms of testing, and reference values corrected for anatomical site, age, and gender. Interpretation of results should always take into account the clinical context, and patients with language and cognitive difficulties, anxiety, or litigation should not be considered eligible for QST. When appropriate standards, as discussed here, are applied, QST can provide important and unique information about the functional status of somatosensory system, which would be complementary to already existing clinical methods.read more
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Journal ArticleDOI
Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms
TL;DR: Better understanding of allodynia and hyperalgesia might provide clues to the underlying pathophysiology of neuropathic pain and, as such, they represent new or additional endpoints in pain trials.
Journal ArticleDOI
Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles.
R. Baron,Christoph Maier,Nadine Attal,Andreas Binder,Didier Bouhassira,Giorgio Cruccu,Nanna B. Finnerup,Maija Haanpää,Per Hansson,Per Hansson,Philipp Hüllemann,Troels S. Jensen,Rainer Freynhagen,Jeffrey D. Kennedy,Walter Magerl,Tina Mainka,Tina Mainka,Maren Reimer,Andrew S.C. Rice,Märta Segerdahl,Märta Segerdahl,Jordi Serra,Søren H. Sindrup,Claudia Sommer,Thomas R. Tölle,Jan Vollert,Jan Vollert,Rolf-Detlef Treede +27 more
TL;DR: A new approach of subgrouping patients with peripheral neuropathic pain of different etiologies according to intrinsic sensory profiles is presented, which may be related to pathophysiological mechanisms and may be useful in clinical trial design to enrich the study population for treatment responders.
Journal ArticleDOI
Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations.
Robert R. Edwards,Robert H. Dworkin,Dennis C. Turk,Martin S. Angst,Raymond A. Dionne,Roy Freeman,Per Hansson,Simon Haroutounian,Lars Arendt-Nielsen,Nadine Attal,R. Baron,Joanna M. Brell,Shay Bujanover,Laurie B. Burke,Daniel B. Carr,Amy S. Chappell,Penney Cowan,Mila Etropolski,Roger B. Fillingim,Jennifer S. Gewandter,Nathaniel P. Katz,Ernest A. Kopecky,John D. Markman,George G. Nomikos,Linda Porter,Bob A. Rappaport,Andrew S.C. Rice,Joseph M. Scavone,Joachim Scholz,Lee S. Simon,Shannon M. Smith,Jeffrey Tobias,Tina Tockarshewsky,Christine Veasley,Mark Versavel,Ajay D. Wasan,Warren Wen,David Yarnitsky +37 more
TL;DR: Evidence is presented on the most promising phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics.
Journal ArticleDOI
Can quantitative sensory testing move us closer to mechanism-based pain management?
TL;DR: Although evidence suggests that QST may be useful in a mechanism-based classification of pain, there are gaps in current understanding that need to be addressed including making QST more applicable in clinical settings.
Journal ArticleDOI
Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions
David A Rice,Jo Nijs,Eva Kosek,Timothy H. Wideman,Monika Hasenbring,Kelli F. Koltyn,Thomas Graven-Nielsen,Andrea Polli +7 more
TL;DR: This article provides a contemporary review of the acute effects of exercise on pain and pain sensitivity, including in people with chronic pain conditions, and discusses possible biological mechanisms and potential influence of sex and psychosocial factors.
References
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Journal ArticleDOI
Limitations of quantitative sensory testing when patients are biased toward a bad outcome
Peter J. Dyck,Peter J. Dyck,William R. Kennedy,H. Kesserwani,Michel Melanson,J. Ochoa,Michael E. Shy,J. C. Stevens,Guillermo A. Suarez,P. C. O'Brien +9 more
TL;DR: Because hyperesthesia precedes hypoesthesia in progressive neuropathy, this test is sensitive to the earliest stages of neuropathy associated with conditions such as diabetes and carpal tunnel syndrome.
Journal ArticleDOI
Pain-associated mild sensory deficits without hyperalgesia in chronic non-neuropathic pain
Andrea Westermann,Anne-Kathrin Rönnau,Elena K. Krumova,Sabrina Regeniter,Peter Schwenkreis,Roman Rolke,Rolf-Detlef Treede,Helmut Richter,Christoph Maier +8 more
TL;DR: It is suggested that chronic non-neuropathic pain may induce slight sensory impairment for large Fiber function (bilateral) and small fiber function (ipsilateral), however, all changes are within the normal range, in contrast to patients with neuropathy.
Journal ArticleDOI
How to detect a sensory abnormality
Rolf-Detlef Treede,Ralf Baron +1 more
TL;DR: A retrospective analysis of bedside sensory examination (BE) and quantitative sensory testing (QST) in a group of 32 patients with neuropathic pain following nerve injury reports that BE and QST gave the same finding in only half of the patients, and that bedside examination was more sensitive than QST in the other half.
Journal ArticleDOI
A comparison of the new indicator test for sudomotor function (Neuropad) with the vibration perception threshold and the clinical examination in the diagnosis of peripheral neuropathy in subjects with type 2 diabetes.
Nikolaos Papanas,Konstantinos Papatheodorou,Dimitrios Papazoglou,C. Monastiriotis,D Christakidis,E. Maltezos +5 more
TL;DR: The indicator test appears to be a useful additional diagnostic tool of neuropathy, particularly suitable for screening and self-examination, in type 2 diabetes.
Journal ArticleDOI
Clinical versus quantitative vibration assessment: improving clinical performance
TL;DR: Using a stepwise multivariate analysis, demographic and anthropomorphic patient characteristics associated with the difference between CVI and QVT for the various cohorts and the chosen QVT ranges of percentile abnormality are assessed.
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