Clinical neurophysiology laboratory tests to assess the nociceptive system in humans

This paper presents some currently available neurophysiological tools that are helpful in the clinical setting to evaluate and document neuropathic disturbances that may be associated with pain. The specific tests described in this discussion are quantitative sensory tests (QSTs), autonomic tests (ATs), microneurography (MCNG), and laser evoked potentials (LEPs). Quantitative sensory testing of the nociceptive system includes the thermal stimulation (TST) and current perception threshold (CPT) tests. The ATs applicable to some patients with pain are sudomotor and vasomotor tests. The quantitative sudomotor axon reflex test (QSART), resting sweat output (RSO), and sympathetic skin response (SSR) are the tests for sudomotor involvement. The vasomotor system is tested by measuring skin temperature (surface thermistor or thermography) at rest and, in some cases, after provocative maneuvers. In addition, MCNG (intraneural recording of single nerve fibers or fascicles of nerves) allows examiners to look directly at muscle and skin sympathetic efferent output in normal subjects without pain or with experimental pain and in patients with neuropathic pain. This technique also provides a means of studying the physiology of primary afferent fibers in persons with neurogenic pain. Recent development of LEPs that incorporate the use of painful infrared laser-induced stimuli allow selective study of the nociceptive system, both the central and peripheral portions.