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Quantitative sensory testing using DFNS protocol in Europe

an evaluation of heterogeneity across multiple centers in patients with peripheral neuropathic pain and healthy subjects

Vollert, Jan; Attal, Nadine; Baron, Ralf; Freynhagen, Rainer; Haanpää, Maija; Hansson, Per; Jensen, Troels S.; Rice, Andrew S.C.; Segerdahl, Märta; Serra, Jordi; Sindrup, Soeren H.; Tölle, Thomas R.; Treede, Rolf-Detlef; Maier, Christoph

doi: 10.1097/j.pain.0000000000000433
Research Paper

Quantitative sensory testing (QST) in accordance with the DFNS (German Research Network on Neuropathic Pain) protocol assesses the function of afferent nerve fibers on the basis of 13 parameters. Within the consortia IMI (Innovative Medicines Initiative) Europain and Neuropain, QST results from pain research units experienced in QST across Europe can be compared for the first time. Aim of this analysis was to identify possible biases in the QST assessment between 10 centers from 8 different European countries. In total, 188 healthy subjects, 217 patients with painful polyneuropathy, and 150 patients with painful peripheral nerve injury were included in the analysis. Mixed effects models were constructed for each of the 11 normally distributed QST parameters with z-value as the dependent variable, and center as the random effect. The I2 statistic for heterogeneity was calculated, an index ranging from 0% (no heterogeneity) to 100% (perfect heterogeneity). Data from healthy subjects were comparable with the existing reference data base. Patients with polyneuropathy mainly displayed loss of sensory function, whereas patients with peripheral nerve injury often showed sensory loss combined with mechanical hyperalgesia. Heterogeneity was overall low between different centers and parameters. There was no systematic heterogeneity for patients with painful peripheral nerve injury and painful polyneuropathy. For healthy subjects, only blunt pressure pain threshold showed a considerable heterogeneity of 42% (95% confidence interval: 0%-66%). In conclusion, QST of both healthy subjects and patients with peripheral neuropathic pain is largely homogenous within the European centers, an essential prerequisite for performing multicenter QST-based studies.

Ten specialized pain centers across Europe show similar results in the QST-assessment of patients with peripheral neuropathic pain and healthy subjects.

aDepartment of Pain Medicine, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Bochum, Germany

bCenter of Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany

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

dUniversité Versailles-Saint-Quentin, Versailles, France

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

fDepartment of Anaesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Tutzing, Tutzing, Germany

gDepartment of Anaethesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

hHelsinki University Central Hospital, Helsinki, Finland

iEtera Mutual Pension Insurance Company, Helsinki, Finland

jDepartment of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway

kDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

lDepartment of Neurology, Danish Pain Research Center, Aarhus University Hospital, Denmark

mPain Research, Department of Surgery and Cancer, Imperial College, London, United Kingdom

nH. Lundbeck A/S, Copenhagen, Denmark

oDepartment of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

pNeuroscience Technologies, Ltd, Barcelona, Spain

qDepartment of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark

rDepartment of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

Corresponding author. Address: Department of Pain Medicine, University Hospital Bergmannsheil Bochum GmbH, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany. Tel.: +49 234/302-6232; fax: +49 234/302-6367. E-mail address: (J. Vollert).

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

Received September 15, 2015

Received in revised form November 10, 2015

Accepted November 12, 2015

© 2016 International Association for the Study of Pain
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