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A Protocol of Manual Tests to Measure Sensation and Pain in Humans
Published on: December 19, 2016
Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): reference data for the trunk
Doreen B Pfau1, Elena K Krumova, Rolf-Detlef Treede
1Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany Division of Neurological Pain Research and Therapy, Department of Neurology, Universitaetsklinikum Schleswig-Holstein, Campus Kiel, Germany Department of Neurology, Technische Universität, München, Germany Department of Neurology, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany Department of Biological and Clinical Psychology, Institute of Psychology, Friedrich Schiller University, Jena, Germany Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany.
Abstract:
Age- and gender-matched reference values are essential for the clinical use of quantitative sensory testing (QST). To extend the standard test sites for QST-according to the German Research Network on Neuropathic Pain-to the trunk, we collected QST profiles on the back in 162 healthy subjects. Sensory profiles for standard test sites were within normal interlaboratory differences. QST revealed lower sensitivity on the upper back than the hand, and higher sensitivity on the lower back than the foot, but no systematic differences between these trunk sites. Age effects were significant for most parameters. Females exhibited lower pressure pain thresholds (PPT) than males, which was the only significant gender difference. Values outside the 95% confidence interval of healthy subjects (considered abnormal) required temperature changes of >3.3-8.2 °C for thermal detection. For cold pain thresholds, confidence intervals extended mostly beyond safety cutoffs, hence only relative reference data (left-right differences, hand-trunk differences) were sufficiently sensitive. For mechanical detection and pain thresholds, left-right differences were 1.5-2.3 times more sensitive than absolute reference data. The most sensitive parameter was PPT, where already side-to-side differences >35% were abnormal. Compared to trunk reference data, patients with postherpetic neuralgia exhibited thermal and tactile deficits and dynamic mechanical allodynia, mostly without reduced mechanical pain thresholds. This pattern deviates from other types of neuropathic pain. QST reference data for the trunk will also be useful for patients with postthoracotomy pain or chronic back pain.
