Can Quantitative Sensory Testing Move Us Closer to Mechanism-Based Pain Management?

Abstract

Objective This review summarizes the scientific literature relating to the use of quantitative sensory testing (QST) for mechanism-based pain management. Design A literature search was undertaken using PubMed and search terms including quantitative sensory testing, pain, chronic pain, response to treatment, outcome measure. Settings and Patients Studies including QST in healthy individuals and those with painful disorders were reviewed. Measures Publications reported on QST methodological issues including associations among measures and reliability. We also included publications on the use of QST measures in case-control studies, their associations with biopsychosocial mechanisms, QST measures predicting clinical pain as well as predicting and reflecting treatment responses. Results Although evidence suggests that QST may be useful in a mechanism-based classification of pain, there are gaps in our current understanding that need to be addressed including making QST more applicable in clinical settings. There is a need for developing shorter QST protocols that are clinically predictive of various pain subtypes and treatment responses without requiring expensive equipment. Future studies are needed examining the clinical predictive value of QST including sensitivity and specificity for pain classification or outcome prediction. These findings could enable third-party payers’ reimbursement, which would facilitate clinical implementation of QST. Conclusions With some developments, QST could become a cost-effective and clinically useful component of pain assessment and diagnosis, which can further our progress toward the goal of mechanism-based personalized pain management.

Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis

“…PPT and CPT both measure A-delta and C-afferents, but with mechanical, respectively, thermal stimuli [7]. In this study, CPT had no associations with psychological factors pre-surgery, while lowered PPT was associated with more anxiety-and depression signs and lower self-efficacy.…”

“…Our material was too small to adjust the regressions for possible confounding factors, e.g., psychological factors. Further, temporal summation or other dynamic QST could have been of interest, since these have been recommended to assess pain experience [7]. The difference in age between patients with disc herniation and spinal stenosis does probably not explain the differences in results since a strength of our study is that regression model was adjusted for age.…”

“…Development of less time consuming QST protocols are needed [7]. The handheld electrical pressure algometer used for PPT measurement is more or less standard equipment and more feasible in Spine Clinics.…”

“…Another reported risk factor is insufficient pain treatment pre-and post-surgery [6]. It has been suggested that screening of somatosensory function may contribute to the understanding of pain mechanisms involved [7]. Somatosensory profiles can be assessed with quantitative sensory testing (QST), by measuring amongst others pressure-, cold-and heat pain thresholds (PPT, CPT and HPT).…”

Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders

“…One alternative is to analyse the somatosensory function of pain by quantitative sensory testing (QST) (88), and this may also contribute to an understanding of the pain mechanisms involved (88). Detection thresholds, pain thresholds, and pain summation among other test for pain sensitivity can be measured by QST (89).…”