Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus

Abstract

Quantitative sensory testing (QST) is a psychophysical method used to quantify somatosensory function in response to controlled stimuli in healthy subjects and patients. Although QST shares similarities with the quantitative assessment of hearing or vision, which is extensively used in clinical practice and research, it has not gained a large acceptance among clinicians for many reasons, and in significant part because of the lack of information about standards for performing QST, its potential utility, and interpretation of results. A consensus meeting was convened by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) to formulate recommendations for conducting QST in clinical practice and research. Research studies have confirmed the utility of QST for the assessment and monitoring of somatosensory deficits, particularly in diabetic and small fiber neuropathies; the assessment of evoked pains (mechanical and thermal allodynia or hyperalgesia); and the diagnosis of sensory neuropathies. Promising applications include the assessment of evoked pains in large-scale clinical trials and the study of conditioned pain modulation. In clinical practice, we recommend the use QST for screening for small and large fiber neuropathies; monitoring of somatosensory deficits; and monitoring of evoked pains, allodynia, and hyperalgesia. QST is not recommended as a stand-alone test for the diagnosis of neuropathic pain. For the conduct of QST in healthy subjects and in patients, we recommend use of predefined standardized stimuli and instructions, validated algorithms of testing, and reference values corrected for anatomical site, age, and gender. Interpretation of results should always take into account the clinical context, and patients with language and cognitive difficulties, anxiety, or litigation should not be considered eligible for QST. When appropriate standards, as discussed here, are applied, QST can provide important and unique information about the functional status of somatosensory system, which would be complementary to already existing clinical methods.

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

“…QST has been recommended as both a phenotyping and outcome measure in clinical trials of analgesics [26,41], and we have used these standardized psychophysical tests in a number of prior studies [23,42,43].…”

“…Long-term opioid users showed significantly greater temporal summation of pain (TSP) than nonusers [16], while another study reported that conditioned pain modulation (CPM) was significantly lower in long-term opioid users [24]. In humans, TSP and CPM are well-established psychophysical tools commonly used for assessing endogenous pain-facilitation and pain-inhibition, respectively, and these pain-modulatory systems play an important role in shaping pain transmission and perception at spinal and supraspinal levels [25][26][27]. Prior work has shown repeatedly that enhanced TSP and diminished CPM are associated with heightened clinical pain across various types of chronic pain conditions [28][29][30].…”

Improvement of sensory function after sequestrectomy for lumbar disc herniation: a prospective clinical study using quantitative sensory testing

“…Accurate detection and quantification of the severity of a sensory disturbance have been imprecise. Quantitative sensory testing (QST) offers the possibility to investigate a patient's somatosensory profile accurately [4].…”

Distal Sensorimotor Neuropathy: Improvements in Diagnosis

“…Furthermore, QST may have an important role in the quantification of positive sensory symptoms such as allodynia and hyperalgesia [98]. In their recent consensus document, the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) recommended the use of QST for screening for small and large fiber neuropathies, monitoring of somatosensory deficits, and monitoring of evoked pains, allodynia, and hyperalgesia [99]. The group also suggested using QST as the sole test for diagnosis of neuropathic pain.…”