scholarly journals Local and Systemic Analgesic Effects of Nerve-Specific Acupuncture in Healthy Adults, Measured by Quantitative Sensory Testing

Pain Medicine ◽  
2019 ◽  
Author(s):  
Alexandra Dimitrova ◽  
Dana Dharmakaya Colgan ◽  
Barry Oken
Keyword(s):  
Dose Response ◽  
Repeated Measures ◽  
Quantitative Sensory Testing ◽  
Pain Perception ◽  
Detection Threshold ◽  
High Dose ◽  
Heat Pain ◽  
Sensory Testing ◽  
Analgesic Effects ◽  
Heat Pain Threshold

Abstract Objective  This study aims to assess whether acupuncture analgesia’s effects are local or systemic and whether there is a dose response for these effects. Methods  Twenty-eight healthy volunteers aged 18–45 were randomized to two doses of acupuncture using points closely associated with peripheral nerves in the legs. The lower-dose group involved acupoints overlying the deep peroneal nerve (DP), and the higher-dose involved acupoints overlying the deep peroneal and posterior tibial nerves (DPTN). Baseline and acupuncture quantitative sensory testing (QST) assessments were obtained locally in the calf and great toe and systemically in the hand. Results were analyzed using factorial repeated-measures analysis of variance for each of the QST variables—cold detection threshold (CDT), vibration detection threshold (VDT), heat pain threshold (HP0.5), and heat pain perception of 5/10 (HP5.0). Location (leg/hand) and time (baseline/acupuncture) were within-subject factors. Intervention (DP/DPTN) was a between-subject factor. Results  CDT was increased in the calf (P < 0.001) and in the hand (P < 0.001). VDT was increased in the toe (P < 0.001) but not in the hand. HP0.5 was increased in the calf (P < 0.001) and in the hand (P < 0.001). HP5.0 was increased in the calf (P = 0.002) and in the hand (P < 0.001), with the local effect being significantly greater than the systemic (P = 0.004). In all of the above QST modalities, there was no difference between the low-dose (DP) and high-dose (DPTN) acupuncture groups. Conclusions  Acupuncture caused comparable local and systemic analgesic effects in cold detection and heat pain perception and only local effects in vibration perception. There was no clear acupuncture dose response to these effects.

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.

scholarly journals Pain sensitivity in young adults with juvenile idiopathic arthritis: a quantitative sensory testing study

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Ellen Dalen Arnstad ◽  
Johanne Marie Iversen ◽  
Martin Uglem ◽  
Mia Glerup ◽  
Pål Richard Romundstad ◽  
...  
Keyword(s):  
Young Adults ◽  
Quantitative Sensory Testing ◽  
Pain Sensitivity ◽  
Pain Perception ◽  
Disease Duration ◽  
Heat Pain ◽  
Sensory Testing ◽  
Pain Thresholds ◽  
First Time ◽  
Age And Sex

Abstract Background To study for the first-time, pain perception, pain sensitivity, and self-reported pain in young adults with long disease duration of juvenile idiopathic arthritis (JIA) compared with controls. Methods Children from Central Norway diagnosed with JIA between 1997 and 2004 were included consecutively in a population-based prospective study. Children with onset 1997–2000 were part of the Nordic JIA cohort. Controls were age- and sex-matched. In 2015–2017, study visits with investigator-blinded quantitative sensory testing (QST) comprising cold and warm detection thresholds (CDT/WDT), cold and heat pain thresholds (CPT/HPT), pressure pain threshold (PPT), and a suprathreshold heat pain test were performed. We constructed separate multilevel models for each variable of detection and pain thresholds with interaction between groups and site adjusted for the effect of age and sex. Results Among 96 young adults with JIA, 71% were female, median age was 22.7 years, disease duration was 16.1 years, and 47% had oligoarticular disease. Among 109 controls, 71% were female, and median age was 23.5 years. Participants with JIA had lower pressure pain thresholds (PPTs) (95% CI) compared to controls, upper limb 888 (846,930) versus 1029 (999,1059) kPa and lower limb 702 (670,734) versus 760 (726,794) kPa. Participants with inactive disease had the lowest PPTs and cold pain thresholds (CPTs), compared to those in remission off medication and those with active disease. Minor differences were found regarding CDT/WDT and CPT/HPT in JIA compared to controls. The median (IQR) temperature needed to evoke pain = 6 on a 0–10 numeric rating scale (NRS) in the suprathreshold heat pain tests were lower in JIA than in controls (46 °C (45–47 °C) versus 47 °C (46–48 °C)). We found no associations between self-reported pain and pain thresholds. Conclusions Our results indicate for the first time that young adults with long disease duration of JIA may have altered pain perception and sensitivity compared to controls. A clinical implication may be the importance of early treatment to quickly achieve pain-free remission and avoid long-term pain sensitization.

scholarly journals Patients with Minimal Hepatic Encephalopathy Show Altered Thermal Sensitivity and Autonomic Function

2021 ◽  
Vol 10 (2) ◽  
pp. 239
Author(s):  
Dalia Rega ◽  
Mika Aiko ◽  
Nicolás Peñaranda ◽  
Amparo Urios ◽  
Juan-José Gallego ◽  
...  
Keyword(s):  
Nervous System ◽  
Hepatic Encephalopathy ◽  
Quantitative Sensory Testing ◽  
Autonomic Function ◽  
Thermal Sensitivity ◽  
Somatosensory System ◽  
Minimal Hepatic Encephalopathy ◽  
Heat Pain ◽  
Sensory Testing ◽  
Cirrhotic Patients

Cirrhotic patients may experience alterations in the peripheral nervous system and in somatosensory perception. Impairment of the somatosensory system could contribute to cognitive and motor alterations characteristic of minimal hepatic encephalopathy (MHE), which affects up to 40% of cirrhotic patients. We assessed the relationship between MHE and alterations in thermal, vibration, and/or heat pain sensitivity in 58 cirrhotic patients (38 without and 20 with MHE according to Psychometric Hepatic Encephalopathy Score) and 39 controls. All participants underwent attention and coordination tests, a nerve conduction study, autonomic function testing, and evaluation of sensory thresholds (vibration, cooling, and heat pain detection) by electromyography and quantitative sensory testing. The detection thresholds for cold and heat pain on the foot were higher in patients with, than those without MHE. This hyposensitivity was correlated with attention deficits. Reaction times in the foot were longer in patients with, than without MHE. Patients with normal sural nerve amplitude showed altered thermal sensitivity and autonomic function, with stronger alterations in patients with, than in those without MHE. MHE patients show a general decrease in cognitive and sensory abilities. Small fibers of the autonomic nervous system and thermal sensitivity are altered early on in MHE, before large sensory fibers. Quantitative sensory testing could be used as a marker of MHE.

scholarly journals Validation of a Brazilian quantitative sensory testing (QST) device for the diagnosis of small fiber neuropathies

2011 ◽  
Vol 69 (6) ◽  
pp. 943-948 ◽  
Author(s):  
Pedro Schestatsky ◽  
Luciana Cadore Stefani ◽  
Paulo Roberto Sanches ◽  
Danton Pereira da Silva Júnior ◽  
Iraci Lucena Silva Torres ◽  
...  
Keyword(s):  
Quantitative Sensory Testing ◽  
Stimulus Change ◽  
Heat Pain ◽  
Thermal Perception ◽  
Sensory Testing ◽  
Brazilian Sample ◽  
Small Fiber ◽  
Normal Individuals ◽  
Nociceptive Pathway

Quantitative sensory testing (QST) is defined as the determination of thresholds for sensory perception under controlled stimulus. Our aim was to validate a new QST device for Brazilian sample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm² thermode with a 1°C/s stimulus change rate were applied. Thresholds of three consecutive stimuli were averaged in two different sessions separated by at least two weeks. Additionally long thermal heat pain stimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermal perception thresholds in normal individuals and plausible abnormal thresholds in patients. We conclude that our QST device is reliable when analyzing the nociceptive pathway in controls and patients.

scholarly journals Ejaculatory Pain

2007 ◽  
Vol 107 (2) ◽  
pp. 298-304 ◽  
Author(s):  
Eske K. Aasvang ◽  
Bo Møhl ◽  
Henrik Kehlet
Keyword(s):  
Chronic Pain ◽  
Sexual Dysfunction ◽  
Quantitative Sensory Testing ◽  
Groin Hernia ◽  
Pain Treatment ◽  
Detection Threshold ◽  
Control Group ◽  
Sensory Testing ◽  
Detection Thresholds ◽  
Pain Detection

Background Sexual dysfunction due to ejaculatory and genital pain after groin hernia surgery may occur in approximately 2.5% of patients. However, the specific psychosexological and neurophysiologic characteristics have not been described, thereby precluding assessment of pathogenic mechanisms and treatment strategies. Methods Ten patients with severe pain-related sexual dysfunction and ejaculatory pain were assessed in detail by quantitative sensory testing and interviewed by a psychologist specialized in evaluating sexual functional disorders and were compared with a control group of 20 patients with chronic pain after groin hernia repair but without sexual dysfunction, to identify sensory changes associated with ejaculatory pain. Results Quantitative sensory testing showed significantly higher thermal and mechanical detection thresholds and lowered mechanical pain detection thresholds in both groups compared with the nonpainful side. Pressure pain detection threshold and tolerance were significantly lower in the ejaculatory pain group compared with the control group. 'The maximum pain was specifically located at the external inguinal annulus in all ejaculatory pain patients, but not in controls. The psychosexual interview revealed no major psychosexual disturbances and concluded that the pain was of somatic origin. All patients with ejaculatory pain had experienced major negative life changes and deterioration in their overall quality of life and sexual function as a result of the hernia operation. Conclusions Postherniotomy ejaculatory pain and pain-related sexual dysfunction is a specific chronic pain state that may be caused by pathology involving the vas deferens and/or nerve damage. Therapeutic strategies should therefore include neuropathic pain treatment and/or surgical exploration.

Quantitative Sensory Testing in Patients with Multisomatoform Disorder with Chronic Pain as the Leading Bodily Symptom—a Matched Case–Control Study

Pain Medicine ◽  
2019 ◽  
Author(s):  
Johannes Achenbach ◽  
Anh-Thu Tran ◽  
Burkhardt Jaeger ◽  
Karl Kapitza ◽  
Michael Bernateck ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Quantitative Sensory Testing ◽  
Pain Threshold ◽  
Somatoform Disorders ◽  
Detection Threshold ◽  
Pressure Pain Threshold ◽  
Sensory Profile ◽  
Sensory Loss ◽  
Sensory Testing ◽  
Presenting Symptoms

Abstract Objective Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8–20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients. Design We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls. Results There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results. Conclusions The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.

Value of repeated measures of nerve conduction and quantitative sensory testing in a diabetic neuropathy trial

2006 ◽  
Vol 34 (2) ◽  
pp. 214-224 ◽  
Author(s):  
Shawn J. Bird ◽  
Mark J. Brown ◽  
Cathie Spino ◽  
Sharon Watling ◽  
Howard L. Foyt
Keyword(s):  
Diabetic Neuropathy ◽  
Nerve Conduction ◽  
Repeated Measures ◽  
Quantitative Sensory Testing ◽  
Sensory Testing

scholarly journals Thermal Quantitative Sensory Testing in Fibromyalgia Patients / Termāla Kvantitatīva Sensora Testēšana Fibromialģijas Pacientiem

2015 ◽  
Vol 69 (5) ◽  
pp. 215-222
Author(s):  
Marija Mihailova ◽  
Ināra Logina ◽  
Santa Rasa ◽  
Svetlana Čapenko ◽  
Modra Murovska ◽  
...  
Keyword(s):  
Quantitative Sensory Testing ◽  
Pain Threshold ◽  
Fibromyalgia Impact Questionnaire ◽  
Sensory System ◽  
Thermal Stimulus ◽  
Thermal Perception ◽  
Sensory Testing ◽  
Inhibitory System ◽  
Cold Pain ◽  
Heat Pain Threshold

AbstractFibromyalgia (FM) is a chronic disorder manifested by diffuse musculoskeletal pain, fatigue, sleep, and emotional disturbance. The disorder is probably associated with dysfunction of C and A delta peripheral nerve fibres. Thermal quantitative sensory testing (QST) was used to analyse thinly myelinated A delta fibres and nonmylinated C fibres, which function in the nociceptive sensory system, and the spinothalamic pathway. The observation that FM pain has neuropathic nature increased the value of QST as an additional diagnostic tool. The research group included 51 patients. Somatic symptoms were assessed using the Fatigue Severity Score (FSS), Fibromyalgia Impact Questionnaire (FIQ) and American College of Rheumatology (ACR) 2010 year diagnostic criteria. QST was performed by using thermal stimulus at wrist and feet. QST results were compared with 20 non-FM controls matched for age and sex. FM patients showed significant alteration of thermal perception and pain threshold compared with that in healthy controls, which demonstrated possible neuropathic pain nature in FM patients. Changes were more expressed in warm perception and heat pain threshold, which probably indicates that in FM patients C fibres are more damaged and warm perception and warm pain threshold are more sensitive, which may be used as FM diagnostics. We also found statistically significant negative correlations between warm and cold perception thresholds and between heat and cold pain thresholds, reflecting central sensitization or a defective pain inhibitory system.

scholarly journals Subclinical Peripheral Neuropathy in Patients with Head and Neck Cancer: A Quantitative Sensory Testing (QST) Study

2018 ◽  
Vol 1 (21;1) ◽  
pp. E419-E427 ◽  
Author(s):  
Carlos J. Roldan
Keyword(s):  
Head And Neck Cancer ◽  
Peripheral Neuropathy ◽  
Head And Neck ◽  
Patient Group ◽  
Neck Cancer ◽  
Quantitative Sensory Testing ◽  
Detection Threshold ◽  
Sensory Function ◽  
Dominant Hand ◽  
Sensory Testing

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and chronic complication associated with cancer treatment. Prior investigations have demonstrated the presence of subclinical peripheral neuropathy in patients with colorectal cancer even before the patients had received chemotherapy. Objective: To investigate subclinical peripheral neuropathy of the upper limbs in patients with squamous cell carcinoma (SCC) of the head and neck which developed before their exposure to neurotoxic anticancer agents. Study Design: Retrospective analysis. Methods: With the use of our quantitative sensory testing (QST) data bank, we retrospectively assessed the afferent fiber function of 25 patients with SCC of the head and neck before they had received chemotherapy (the patient group) and compared our findings with those from 23 healthy control patients. Skin temperature, sensorimotor function, sharpness detection, thermal detection, and touch detection (using both von Frey monofilaments and the Bumps detection test) were measured. Results: Touch thresholds were statistically higher in the patient group than in the healthy volunteer group at the palm (mean [± SD], 0.54 g [± 0.07 g] and 0.27 g [± 0.05 g], respectively [P < 0.01]) and at the forearm (0.74 g [± 0.12 g] and 0.41 g [± 0.08 g] [P < 0.05]). There was also a clear deficit in touch sensation as indicated by a Bumps detection threshold in patients of 6.5 µm ± 0.8 µm and in controls of 3.7 µm ± 0.5 µm. This yields an elevation in threshold to 165% in the patients relative to that of the control volunteers. The grooved pegboard test showed delayed completion times for patients compared with controls, with differences of 18.65 seconds in the dominant hand and of 23.36 seconds in the nondominant hand. The sharpness detection thresholds did not differ between patients and volunteers. Limitations: Inadequacies in the original data acquisition and documentation of the QST and the medical records could not be addressed due to the retrospective nature of the study. In addition, based on available information, we did not find an objective parameter able to correlate the QST findings with pre-pain levels. Conclusion: Patients with SCC were found to have deficits in sensory function before undergoing treatment, suggesting that cancer itself alters peripheral nerve function and may contribute to the development of CIPN. These results confirm the sensitivity of the Bumps detection test and highlight its potential role in early detection of peripheral neuropathy, especially in cancer patients for whom chemotherapies associated with CIPN have been prescribed. Key words: Peripheral neuropathy, head and neck cancer, quantitative sensory testing

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