Development of a novel brief quantitative sensory testing protocol that integrates static and dynamic pain assessments: Test-retest performance in healthy adults

Pain Medicine ◽  
2021 ◽  
Author(s):  
Martin J De Vita ◽  
Katherine Buckheit ◽  
Christina E Gilmour ◽  
Dezarie Moskal ◽  
Stephen A Maisto
Keyword(s):  
Quantitative Sensory Testing ◽  
Temporal Summation ◽  
Pain Threshold ◽  
Pain Modulation ◽  
Healthy Adults ◽  
Dynamic Responses ◽  
Conditioned Pain Modulation ◽  
Sensory Testing ◽  
Contact Heat ◽  
Intraclass Correlations

Abstract Objective Quantitative sensory testing is an expanding pain research domain with numerous clinical and research applications. There is a recognized need for brief reliable quantitative sensory testing protocols that enhance assessment feasibility. This study aimed to integrate static (pain threshold, tolerance, suprathreshold) and dynamic (conditioned pain modulation, offset analgesia, temporal summation) pain reactivity measures into a brief 20-minute protocol that uses a single portable device. The test-retest performance of this optimized protocol was evaluated. Design Using a test-retest design, the brief quantitative sensory testing assessment was administered to participants on two occasions separated by exactly 7 days. Setting A clinical psychology research laboratory at Syracuse University. Subjects Participants were 33 healthy adults recruited from Syracuse University’s online research participation pool. Methods A portable computerized quantitative sensory testing device delivered contact-heat pain to assess static and dynamic pain measures in participants. Dynamic responses were continuously recorded using a computerized visual analog scale. Results Pain threshold, tolerance, and suprathreshold exhibited excellent reliability (intraclass correlations ranged from 0.80 to 0.83). Conditioned pain modulation, offset analgesia, temporal summation yielded reliability in the good to excellent range (intraclass correlations ranged from 0.66 to 0.71). Conclusions Findings suggested that this brief integrated QST protocol may reliably monitor human pain reactivity over brief periods. This protocol may enhance quantitative sensory testing feasibility in clinical and research settings.

scholarly journals A pilot study investigating whether quantitative sensory testing alters after treatment in patients with fibromyalgia

2018 ◽  
Vol 12 (4) ◽  
pp. 250-256 ◽  
Author(s):  
Theresa Wodehouse ◽  
Kavita Poply ◽  
Shankar Ramaswamy ◽  
Saowarat Snidvongs ◽  
Julius Bourke ◽  
...  
Keyword(s):  
Pilot Study ◽  
Quantitative Sensory Testing ◽  
Fibromyalgia Impact Questionnaire ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Sensory Testing ◽  
Central Sensitisation ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds

Background: Fibromyalgia is a chronic musculoskeletal pain condition that is often associated with sleep disturbances and fatigue. The pathophysiology of fibromyalgia is not understood, but indirect evidence suggests a central dysfunction of the nociceptive modulating system. The aim of this study was to evaluate whether quantitative sensory testing detects a change in pain thresholds in fibromyalgia patient receiving pregabalin treatment. Methods: A total of 25 patients were recruited for the study and received routine pregabalin, but only 14 patients completed the treatment. Assessment of pressure pain thresholds and changes in conditioned pain modulation using ischaemic pain as a conditioning stimulus were measured at baseline and every 4 weeks for 12 weeks. Fibromyalgia impact questionnaire, PainDETECT and SF-12 were also completed. Results: Patients with fibromyalgia demonstrated a less-efficient conditioned pain modulation at baseline. An efficient conditioned pain modulation was observed at 1 month and this was maintained until the final visit. Pressure pain thresholds (PPTs) showed a significant improvement from baseline. Patients also reported a similar magnitude of improvements in PainDETECT, fibromyalgia impact questionnaire (FIQ) and its impact on daily life and change in outcome for SF-12. Conclusion: This pilot study reports an increase in PPTs and improved conditioned pain modulation response after commencing pregabalin, which was maintained at 12 weeks, and this was supported by positive pain scores. Pregabalin is a licenced treatment for fibromyalgia in Europe, and its response to central sensitisation, particularly ‘dynamic responses’, has not been reported. We conclude that pregabalin has the potential to reduce peripheral and central sensitisation in patients with fibromyalgia, as measured using quantitative sensory testing.

Effect of conditioned pain modulation on trigeminal somatosensory function evaluated by quantitative sensory testing

Pain ◽  
2013 ◽  
Vol 154 (12) ◽  
pp. 2684-2690 ◽  
Author(s):  
Yuka Oono ◽  
Lene Baad-Hansen ◽  
Kelun Wang ◽  
Lars Arendt-Nielsen ◽  
Peter Svensson
Keyword(s):  
Quantitative Sensory Testing ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Sensory Testing ◽  
Somatosensory Function

scholarly journals Conditioned pain modulation assessment using contact heat as conditioning stimulus and two different test stimuli

2019 ◽  
Vol 72 (3-4) ◽  
pp. 66-71
Author(s):  
Aleksandar Knezevic ◽  
Milena Kovacevic ◽  
Ljiljana Klicov ◽  
Magdalena Pantic ◽  
Jana Vasin ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Heat Pain ◽  
Contact Heat ◽  
Pain Thresholds ◽  
Heat Pain Threshold

Introduction. The objective of the study was to determine the potentials and reliability of conditioned pain modulation effect in healthy population by application of a conditioning contact heat stimulus, and heat and pressure applied to the low back region as a test stimulus. Material and Methods. The study included 33 healthy subjects (average age 25.73 ? 5.35 years). Pressure and heat pain thresholds were examined on the paravertebral musculature of the lower back as test stimuli. Contact heat was used on the contralateral forearm as a conditioning stimulus. Conditioned pain modulation was calculated as the difference between pain thresholds after and before conditioning stimulus application. To assess the reliability, identical testing was performed 14 ? 2 days later. Results. The pressure and heat pain thresholds, after the conditioning stimulus, were significantly higher compared to pain thresholds obtained before the conditioning stimulus (101,63 N/cm2 ? 45,21N/cm2 vs 82,15 N/cm2 ? 36,15 N/cm2, t = -7,528, p < 0,001 and 47,08?C ? 2,19o C vs 45,00 ? 3,05?C, t = -6,644, p < 0,001, respectively). The reli?ability of the same protocol, measured 14 ? 2 days after the previous testing, showed good reliability of the pressure pain threshold (intraclass correlation coefficient = 0,636, 95% confidence interval 0,240 - 0,825), and fair of the heat pain threshold (intraclass cor?relation coefficient = 0,435, 95% confidence interval - 0,070 - 0,713). Conclusion. Conditioned pain modulation was successfully induced by contact heat applied via a thermode, a conditioning stimulus. The reliability of this method of testing proved to be fair when it comes to the heat pain threshold and good when it comes to the pressure pain threshold.

scholarly journals Differences in Pain Processing Between Patients with Chronic Low Back Pain, Recurrent Low Back Pain, and Fibromyalgia

2017 ◽  
Vol 4 (20;4) ◽  
pp. 307-318
Author(s):  
Mira Meeus
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Temporal Summation ◽  
Spatial Summation ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pain Processing ◽  
Low Back ◽  
Sensory Testing ◽  
Recurrent Low Back Pain

Background: The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing in LBP remains ambiguous, partly due to the diversity in the LBP population. Objective: The purpose of this study is to compare quantitative sensory assessment in different groups of LBP patients with regard to chronicity. Recurrent low back pain (RLBP), mild chronic low back pain (CLBP), and severe CLBP are compared on the one hand with healthy controls (HC), and on the other hand with fibromyalgia (FM) patients, in which abnormal pain processing has previously been reported. Study Design: Cross-sectional study. Setting: Department of Rehabilitation Sciences, Ghent University, Belgium. Methods: Twenty-three RLBP, 15 mild CLBP, 16 severe CLBP, 26 FM, and 21 HC participated in this study. Quantitative sensory testing was conducted by manual pressure algometry and computercontrolled cuff algometry. A manual algometer was used to evaluate hyperalgesia as well as temporal summation of pain and a cuff algometer was used to evaluate deep tissue hyperalgesia, the efficacy of the conditioned pain modulation and spatial summation of pain. Results: Pressure pain thresholds by manual algometry were significantly lower in FM compared to HC, RLBP, and severe CLBP. Temporal summation of pain was significantly higher in FM compared to HC and RLBP. Pain tolerance thresholds assessed by cuff algometry were significantly lower in FM compared to HC and RLBP and also in severe CLBP compared to RLBP. No significant differences between groups were found for spatial summation or conditioned pain modulation. Limitations: No psychosocial issues were taken into account for this study. Conclusion: The present results suggest normal pain sensitivity in RLBP, but future research is needed. In mild and severe CLBP some findings of altered pain processing are evident, although to a lesser extent compared to FM patients. In conclusion, mild and severe CLBP presents within a spectrum, somewhere between completely healthy persons and FM patients, characterized by pain augmentation. Key words: Low back pain, fibromyalgia, pain assessment, quantitative sensory testing, central sensitization, hypersensitivity, temporal summation, spatial summation, conditioned pain modulation

scholarly journals Simple Quantitative Sensory Testing Reveals Paradoxical Co-existence of Hypoesthesia and Hyperalgesia in Diabetes

2021 ◽  
Vol 2 ◽  
Author(s):  
Line Elise Møller Hansen ◽  
Camilla Ann Fjelsted ◽  
Søren Schou Olesen ◽  
Anna Evans Phillips ◽  
Mahya Faghih ◽  
...  
Keyword(s):  
Quantitative Sensory Testing ◽  
Temporal Summation ◽  
Pain Modulation ◽  
Sensory Response ◽  
Sensory Testing ◽  
Pain Mechanisms ◽  
Cold Pain ◽  
Detection Thresholds ◽  
Sensory Stimuli ◽  
Clinical Endpoints

Background: Diabetic neuropathy is characterized by the paradoxical co-existence of hypo- and hyperalgesia to sensory stimuli. The literature shows consistently sensory differences between healthy and participants with diabetes. We hypothesized that due to differences in pathophysiology, advanced quantitative sensory testing (QST) might reveal sensory discrepancies between type 1 (T1D) and type 2 diabetes (T2D). Furthermore, we investigated whether vibration detection thresholds (VDT) were associated with sensory response.Method: Fifty-six adults with T1D [43 years (28–58)], 99 adults with T2D [65 years (57–71)], and 122 healthy individuals [51 years (34–64)] were included. VDT, pressure pain detection thresholds (pPDT) and tolerance (pPTT), tonic cold pain (hand-immersion in iced water), and central pain mechanisms (temporal summation and conditioned pain modulation) were tested and compared between T1D and T2D. VDT was categorized into normal (&lt; 18 V), intermediary (18–25 V), or high (&gt; 25 V).Results: In comparison to healthy, analysis adjusted for age, BMI, and gender revealed hypoalgesia to tibial (pPDT): p = 0.01, hyperalgesia to tonic cold pain: p &lt; 0.01, and diminished temporal summation (arm: p &lt; 0.01; abdomen: p &lt; 0.01). In comparison to participants with T2D, participants with T1D were hypoalgesic to tibial pPDT: p &lt; 0.01 and pPTT: p &lt; 0.01, and lower VDT: p = 0.02. VDT was not associated with QST responses.Conclusion: Participants with T1D were more hypoalgesic to bone pPDT and pPTT independent of lower VDT, indicating neuronal health toward normalization. Improved understanding of differentiated sensory profiles in T1D and T2D may identify improved clinical endpoints in future trials.

scholarly journals Central Sensıtızatıon ın Axıal Spondyloarthrıtıs: An Exploratıve Study wıth Quantıtatıve Sensory Testıng and Clınıcal Scales

2021 ◽  
Author(s):  
Feyza Nur Yücel ◽  
Mehmet Tuncay Duruöz
Keyword(s):  
Central Sensitization ◽  
Quantitative Sensory Testing ◽  
Axial Spondyloarthritis ◽  
Pressure Pain Threshold ◽  
Female Gender ◽  
Pain Modulation ◽  
Sensory Testing ◽  
Clinical Scales ◽  
Significant Difference ◽  
And Control

ABSTRACT Objective To evaluate the central sensitization (CS) and the related parameters in patients with axial spondyloarthritis (axSpA). Methods Quantitative sensory testing (QST) which consists of pressure pain threshold (PPT), temporal summation (TS), and conditioned pain modulation (CPM) were applied to the participants. Disease activity, functional status, sleep quality, pain, depression, and fatigue were assessed. Patients were divided as the ones with and without CS according to the central sensitization inventory (CSI) and the results were compared. Results One hundred patients and fifty controls were recruited. Sixty axSpA patients had CS. When QST results were compared between the patient and control groups, all PPT scores were found lower (p&lt;0.05) in patients. Regarding the comparison of the patients with and without CS, sacroiliac, and trapezius PPT scores were found lower in the patients with CS (p&lt;0.05). On the other hand, there was no significant difference in the mean TS scores (p&gt;0.05) between patients and controls, and in patients with and without CS. All investigated comorbidities were found to be significantly more frequent (p&lt;0.001) in the patients with CS. In regression analysis female gender, morning stiffness duration, CPM, depression, and fatigue were detected as related parameters with CSI scores. Conclusion CS and related comorbidities were found to be increased in axSpA patients. This increase should be taken into consideration in the management of these patients.

scholarly journals Quantitative sensory testing predicts histological small fiber neuropathy in postural tachycardia syndrome

2019 ◽  
Vol 10 (5) ◽  
pp. 428-434
Author(s):  
Sophia C.I. Billig ◽  
Joana C. Schauermann ◽  
Roman Rolke ◽  
Istvan Katona ◽  
Jörg B. Schulz ◽  
...  
Keyword(s):  
Skin Biopsy ◽  
Quantitative Sensory Testing ◽  
Pain Threshold ◽  
Detection Threshold ◽  
Small Fiber Neuropathy ◽  
Sensory Testing ◽  
Cold Pain ◽  
Noninvasive Test ◽  
Small Fiber ◽  
Heat Pain Threshold

BackgroundRetrospective investigation of the somatosensory profile and prediction of histologic small fiber neuropathy (SFN) in postural orthostatic tachycardia syndrome (POTS) was performed using quantitative sensory testing (QST) as a standardized noninvasive test.MethodsIn this investigation, full data sets from 30 patients (age: 34.03 ± 10.82 years, n = 6 males), including results of autonomic function testing, norepinephrine values, skin biopsy, and QST, were retrospectively analyzed. The QST data were compared with healthy controls (HCs) (age: 34.20 ± 10.5 years, n = 6 males, t test: 0.95).ResultsThe evaluation of all QST parameters in POTS compared with HCs yielded differences in all thermal parameters (cold detection threshold: p < 0.05, warm detection threshold: p < 0.001, thermal sensory limen: p < 0.001, cold pain threshold: p < 0.05, and heat pain threshold: p < 0.001) and in paradoxical heat sensations (p < 0.05). Differences in nonpainful stimuli (mechanical detection threshold: p < 0.05 and vibration detection threshold: p < 0.001) were also detected. All patients who had clinical signs of SFN in combination with impairment of small fibers in QST also had SFN on skin biopsy.ConclusionThese results suggest that a non–region-specific SFN in POTS compared with controls can be detected by noninvasive QST that predicts histologic small fiber pathology.

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