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Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus

Backonja, Miroslav “Mishaa,b,*”; Attal, Nadinec,d; Baron, Ralfe; Bouhassira, Didierc,d; Drangholt, Markf; Dyck, Peter J.g; Edwards, Robert R.h; Freeman, Royi; Gracely, Richardj; Haanpaa, Maija H.k; Hansson, Perl; Hatem, Samar M.m,n,o; Krumova, Elena K.p; Jensen, Troels S.q; Maier, Christophr; Mick, Gerards; Rice, Andrew S.t,u; Rolke, Romanv; Treede, Rolf-Detlefw,x,y; Serra, Jordiz; Toelle, Thomasaa; Tugnoli, Valeriab; Walk, Davidac; Walalce, Mark; Ware, Markae; Yarnitsky, Davidaf; Ziegler, Danag

doi: 10.1016/j.pain.2013.05.047

Summary Standards for conducting quantitative sensory testing (QST), which is a psychophysical method used to quantify somatosensory function in response to controlled stimuli in healthy subjects and patients, is discussed, and recommendations on the basis of current status of QST are presented.

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.

aDepartment of Neurology, University of Wisconsin-Madison, Madison, WI, USA

bCRI Lifetree Research, Salt Lake City, UT, USA

cINSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France

dUniversité Versailles Saint-Quentin, France

eDivision of Neurological Pain Research and Therapy, Department of Neurology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany

fDental Public Health Sciences, University of Washington, Seattle, WA, USA

gMayo Clinic, 200 First Street SW, Rochester, MN, USA

hDepartment of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA

iDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

jCenter for Neurosensory Disorders, University of North Carolina, CB No. 7280, 3330 Thurston Bldg, Chapel Hill, NC, USA

kDepartment of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland

lClinical Pain Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden

mClinic of Physical and Rehabilitation Medicine, Brugmann University Hospital, 4 place Van Gehuchten, B-1020 Brussels, Belgium

nInstitute of Neuroscience, 52, Avenue E. Mounier, B-1200 Brussels, Belgium

oUniversité Catholique de Louvain, Leuven, Belgium

pDepartment of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Germany

qDanish Pain Research Center and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark

rDepartment of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Germany

sCenter for Pain Evaluation and Treatment, University Neurological Hospital, Lyon, France

tImperial College London, UK

uChelsea and Westminster Hospital London, UK

vDepartment of Palliative Medicine, Rheinische Friedrich-Wilhelms University, Bonn, Germany

wDepartment of Neurology, MC Mutual, Barcelona, Spain

xNeuroscience Technologies, Barcelona, Spain

yNeuroscience Technologies, London, UK

zDepartment of Neurology, Technische Universität München, Munich, Germany

aaChair of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim, Heidelberg University, Heidelberg, Germany

abDepartment of Neuroscience and Rehabilitation, S. Anna University Hospital of Ferrara, Ferrara, Italy

acUniversity of Minnesota, 425 Delaware St SE, MMC 295, Minneapolis, MN, USA

adDepartment of Anesthesiology, University of California-San Diego, La Jolla, CA, USA

aeDepartment of Family Medicine and Department of Anesthesia, McGill University, Montreal, Quebec, Canada

afDepartment of Neurology, Rambam Health Care Campus, Haifa, Israel

agInstitute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research and Department of Metabolic Diseases, University Hospital, Düsseldorf, Germany

* Corresponding author at: Department of Neurology, University of Wisconsin-Madison, Madison, WI, USA.


Article history:

Received 18 October 2012

Received in revised form 21 April 2013

Accepted 29 May 2013

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

© 2013 Lippincott Williams & Wilkins, Inc.
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