Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus |
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| Authors: | Miroslav &ldquo Misha&rdquo Backonja,Nadine Attal,Ralf Baron,Didier Bouhassira,Mark Drangholt,Peter J. Dyck,Robert R. Edwards,Roy Freeman,Richard Gracely,Maija H. Haanpaa,Per Hansson,Samar M. Hatem,Elena K. Krumova,Troels S. Jensen,Christoph Maier,Gerard Mick,Andrew S. Rice,Roman Rolke,Rolf-Detlef Treede,Jordi Serra,Thomas Toelle,Valeri Tugnoli,David Walk,Mark S. Walalce,Mark Ware,David Yarnitsky,Dan Ziegler |
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| Affiliation: | 1. Department of Neurology, University of Wisconsin-Madison, Madison, WI, USA;2. CRI Lifetree Research, Salt Lake City, UT, USA;3. INSERM U-987, Centre d’Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France;4. Université Versailles Saint-Quentin, France;5. Division of Neurological Pain Research and Therapy, Department of Neurology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany;6. Dental Public Health Sciences, University of Washington, Seattle, WA, USA;g Mayo Clinic, 200 First Street SW, Rochester, MN, USA;h Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, USA;i Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;j Center for Neurosensory Disorders, University of North Carolina, CB No. 7280, 3330 Thurston Bldg, Chapel Hill, NC, USA;k Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland;l Clinical Pain Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden;m Clinic of Physical and Rehabilitation Medicine, Brugmann University Hospital, 4 place Van Gehuchten, B-1020 Brussels, Belgium;n Institute of Neuroscience, 52, Avenue E. Mounier, B-1200 Brussels, Belgium;o Université Catholique de Louvain, Leuven, Belgium;p Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Germany;q Danish Pain Research Center and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark;r Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Germany;s Center for Pain Evaluation and Treatment, University Neurological Hospital, Lyon, France;t Imperial College London, UK;u Chelsea and Westminster Hospital London, UK;v Department of Palliative Medicine, Rheinische Friedrich-Wilhelms University, Bonn, Germany;w Department of Neurology, MC Mutual, Barcelona, Spain;x Neuroscience Technologies, Barcelona, Spain;y Neuroscience Technologies, London, UK;z Department of Neurology, Technische Universität München, Munich, Germany;aa Chair of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim, Heidelberg University, Heidelberg, Germany;ab Department of Neuroscience and Rehabilitation, S. Anna University Hospital of Ferrara, Ferrara, Italy;ac University of Minnesota, 425 Delaware St SE, MMC 295, Minneapolis, MN, USA;ad Department of Anesthesiology, University of California-San Diego, La Jolla, CA, USA;ae Department of Family Medicine and Department of Anesthesia, McGill University, Montreal, Quebec, Canada;af Department of Neurology, Rambam Health Care Campus, Haifa, Israel;ag Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research and Department of Metabolic Diseases, University Hospital, Düsseldorf, Germany |
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| 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. |
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