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Quantitative Sensory Testing in Measurement of Neuropathic Pain Phenomena and Other Sensory Abnormalities

Backonja, Miroslav-Misha MD*; Walk, David MD; Edwards, Robert R. PhD; Sehgal, Nalini MD*; Moeller-Bertram, Toby MD§; Wasan, Ajay MD; Irving, Gordon MD; Argoff, Charles MD; Wallace, Mark MD§

doi: 10.1097/AJP.0b013e3181a68c7e
Review Articles

Neuropathic pain disorders are usually characterized by spontaneous ongoing or intermittent symptoms, stimulus-evoked positive sensory phenomena, and negative sensory phenomena. Spontaneous individual subject specific phenomena are identified in the neurologic history and are quantifiable by means of self-reported neuropathic pain symptoms tools such as scales, inventories, and questionnaires. Negative and positive sensory phenomena are assessed by the neurologic bedside examination and quantitative sensory testing (QST), which refers to psychophysical tests of sensory perception during the administration of stimuli with predetermined physical properties and following specific protocols. QST is able to capture and quantify stimulus-evoked negative and positive sensory phenomena, and as such should become standard if not a critical tool in neuropathic pain research and practice. Although the advent of anatomic and functional imaging modalities is revolutionizing our understanding of the mechanisms of neuropathic pain, only by anchoring such test results to individual subjects' own perceptions via QST can they provide meaningful information about neuropathic pain, which is based on perceptual experience. To yield useful results, QST requires a cooperative subject and carefully standardized methods, including standardization of the stimulus parameters as well as the testing environment, instructions, and evaluation methods. This manuscript provides a concise review of fundamental concepts necessary for understanding the role of QST in the process of eliciting information about sensory abnormalities associated with neuropathic pain and the place of that information in analysis of pain mechanisms. Together with the companion manuscript, this review provides definitions that should help further the use of QST as a diagnostic tool as well.

*University of Wisconsin, Madison

University of Minnesota

Albany Medical College

§University of California San Diago

Swedish Medical Center, Seattle

Harvard Medical School

Reprints: Misha-Miroslav Backonja, MD, Department of Neurology, University of Wisconsin—Madison, 600 Highland Avenue, Madison, WI 53792 (e-mail:

Received for publication January 16, 2008; revised November 6, 2008; accepted January 19, 2009

© 2009 Lippincott Williams & Wilkins, Inc.