Quantitative Sensory Testing in Spinal Cord Stimulation: A Narrative Review

Area of Science:

• Neurology
• Pain Medicine
• Neuroscience

Background:

• Quantitative sensory testing (QST) is a valuable tool for studying somatosensory system abnormalities in various conditions, particularly chronic pain.
• While QST is common in pharmacologic pain studies, its application in neuromodulation, specifically spinal cord stimulation (SCS), is less explored.
• This review evaluates the potential utility of QST within SCS clinical research protocols.

Purpose of the Study:

• To assess the utility and application of Quantitative Sensory Testing (QST) in Spinal Cord Stimulation (SCS) protocols.
• To review existing literature on QST use in clinical studies involving SCS for neuropathic pain.
• To determine the role of QST in quantifying the effects of SCS on sensory abnormalities.

Main Methods:

• A narrative review of studies utilizing sensory testing in clinical SCS research from 1975 to October 2023.
• Searched PubMed database for relevant studies focusing on QST application in SCS for neuropathic, neuropathic-like, or mixed pain.
• Included 22 small, exploratory studies with heterogeneous methodologies.

Main Results:

• Emerging evidence suggests that assessing dynamic mechanical allodynia and mechanical/thermal temporal summation of pain can quantify responses to different SCS waveforms.
• Four studies employed the full validated German Research Network on Neuropathic Pain QST protocol.
• Sporadic reports indicate potential improvement in sensory deficits for some patients with neuropathic pain receiving SCS, warranting further investigation.

Conclusions:

• Quantitative Sensory Testing (QST) shows promise in evaluating the efficacy of Spinal Cord Stimulation (SCS).
• The adoption of QST, either the full protocol or a shortened version, is recommended for future SCS clinical research.
• Further research is needed to fully elucidate the role of QST in optimizing SCS therapy for neuropathic pain.