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Quantitative assessment of neuropathic pain

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Abstract

Quantitative sensory testing (QST) refers to a group of protocols that allows for quantitative measures of somesthetic function. Several protocols evaluate perceptual threshold, whereas others evaluate perception of stimuli above threshold. Each protocol has its own advantages and disadvantages, but one must always weigh a trade-off between accuracy (with longer protocols) and expediency (with shorter protocols).

In assessing patients with neuropathic pain, one is interested in both positive and negative sensory symptoms. QST studies, using either neuropathic pain patients or healthy volunteers who have been rendered temporarily hyperalgesic, have demonstrated that pain abnormalities can be modality specific. The fact that various pain abnormalities can exist independently of each other suggests that (at least partially) different neuropathologic processes are responsible for each one. Current research suggests that both peripheral sensitization and central sensitization play a role in these abnormal pain conditions, and identification of precise neuropathologic mechanisms is under active investigation.

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References and Recommended Reading

  1. Claus D, Hilz MJ, Neundörfer B: Thermal discrimination thresholds: a comparison of different methods. Acta Neurol Scand 1990, 81:533–540.

    Article  PubMed  CAS  Google Scholar 

  2. Dyck PJ, O’Brien PC, Kosanke JL, et al.: A 4, 2, and 1 stepping algorithm for quick and accurate estimation of cutaneous sensation threshold. Neurology 1993, 43:1508–1512.

    PubMed  CAS  Google Scholar 

  3. Dyck PJ, Zimmerman I, Gillen DA, et al.: Cool, warm, and heat-pain detection thresholds: testing methods and inferences about anatomic distribution of receptors. Neurology 1993, 43:1500–1508.

    PubMed  CAS  Google Scholar 

  4. Dyck PJ, Zimmerman IR, Johnson DM, et al.: A standard test of heat-pain responses using CASE IV. J Neurol Sci 1996, 136:54–63.

    Article  PubMed  CAS  Google Scholar 

  5. Yarnitsky D, Sprecher E: Thermal testing: normative data and repeatability for various test algorithms. J Neurol Sci 1994, 125:39–45.

    Article  PubMed  CAS  Google Scholar 

  6. Yarnitsky D: Quantitative sensory testing. Muscle Nerve 1997, 20:198–204.

    Article  CAS  Google Scholar 

  7. Jamal GA, Hansen S, Weir AI, Ballantyne JP: An improved automated method for the measurement of thermal thresholds. 1. normal subjects. J Neurol Neurosurg Psychiatry 1985, 48:354–360.

    PubMed  CAS  Google Scholar 

  8. Fagius J, Wahren LK: Variability of sensory threshold determination in clinical use. J Neurol Sci 1981, 51:11–27.

    Article  PubMed  CAS  Google Scholar 

  9. Taylor DJ, McGillis SLB, Greenspan JD: Body site variation of heat pain sensitivity. Somatosens Mot Res 1993, 10:455–466.

    PubMed  CAS  Google Scholar 

  10. Price DD, Harkins SW, Baker C: Sensory-affective relationships among different types of clinical and experimental pain. Pain 1987, 28:297–307.

    Article  PubMed  CAS  Google Scholar 

  11. Jensen TS, Bach FW, Kastrup J, et al.: Vibratory and thermal thresholds in diabetics with and without clinical neuropathy. Acta Neurol Scand 1991, 84:326–333.

    Article  PubMed  CAS  Google Scholar 

  12. Raja SN, Meyer RA, Ringkamp M, Campbell JN: Peripheral neural mechanisms of nociception. In Textbook of Pain. Edited by Wall PD, Melzack R. Edinburgh: Churchill Livingstone; 1999:11–57.

    Google Scholar 

  13. Greenspan JD, Kenshalo DR Sr: The primate as a model for the human temperature-sensing system: 2. Area of skin receiving thermal stimulation (spatial summation). Somatosens Res 1985, 2:315–324.

    Article  PubMed  CAS  Google Scholar 

  14. Green BG, Cruz A: "Warmth-insensitive fields": evidence of sparse and irregular innervation of human skin by the warmth sense. Somatosens Mot Res 1998, 15:269–275.

    Article  PubMed  CAS  Google Scholar 

  15. O’Brien PC, Dyck PJ: Procedures for setting normal values. Neurology 1995, 45:17–23.

    PubMed  CAS  Google Scholar 

  16. Bell-Krotoski J, Weinstein S, Weinstein C: Testing sensibility, including touch-pressure, tow-point discrimination, point localization, and vibration. J Hand Ther 1993, 6:114–123.

    PubMed  CAS  Google Scholar 

  17. Greenspan JD, LaMotte RH: Cutaneous mechanoreceptors of the hand: experimental studies and their implications for clinical testing of tactile sensation. J Hand Ther 1993, 6:75–82.

    PubMed  CAS  Google Scholar 

  18. Johnson KO, Van Boven RW, Hsiao SS: The perception of two points is not the spatial resolution threshold. In Touch, Temperature, and Pain in Health and Disease: Mechanisms and Assessments. Edited by Boivie J et al. Seattle: IASP Press; 1994:389–404.

    Google Scholar 

  19. Van Boven RW, Johnson KO: A psychophysical study of the mechanisms of sensory recovery following nerve injury in humans. Brain 1994, 117:149–167.

    Article  PubMed  Google Scholar 

  20. Eliav E, Gracely RH: Sensory changes in the territory of the ingual and inferior alveolar nerves following lower third molar extraction. Pain 1998, 77:191–199.

    Article  PubMed  CAS  Google Scholar 

  21. Kilo S, Schmelz M, Koltzenburg M, Handwerker HO: Different patterns of hyperalgesia induced by experimental inflammation in human skin. Brain 1994, 117:385–396.

    Article  PubMed  Google Scholar 

  22. Pappagallo M, Oaklander AL, Quatrano-Piacentini AL, et al.: Heterogenous patterns of sensory dysfunction in postherpetic neuralgia suggest multiple pathophysiologic mechanisms. Anesthesiology 2000, 92:691–698. A very good example of how QST can be used in a neuropathic pain population to discern differences in the nature of sensory abnormalities. Of particular interest is the demonstration that hyperalgesia or allodynia can be present for a specific type of stimulation, and not for others, in any one patient.

    Article  PubMed  CAS  Google Scholar 

  23. Andrew D, Greenspan JD: Modality-specific hyper-responsivity of regenerated cat cutaneous nociceptors. J Physiol (Lond) 1999, 516(Pt 3):897–906. Demonstrates that nociceptors of regenerated axons can exhibit mechanical sensitization as long as 6 months following a nerve cut and repair. In addition, it shows that nociceptor sensitization can be modality-specific.

    Article  CAS  Google Scholar 

  24. Taylor BK: Pathophysiologic mechanisms of neuropathic pain. Curr Pain Headache Rep 2001, 5:151–161.

    Article  PubMed  CAS  Google Scholar 

  25. Koltzenburg M, Torebjörk HE, Wahren LK: Nociceptor modulated central sensitization causes mechanical hyperalgesia in acute chemogenic and chronic neuropathic pain. Brain 1994, 117:579–591.

    Article  PubMed  Google Scholar 

  26. Ziegler EA, Magerl W, Meyer RA, Treede RD: Secondary hyperalgesia to punctate mechanical stimuli—central sensitization to A-fibre nociceptor input. Brain 1999, 122:2245–2257. Provides strong evidence that punctate allodynia is a result of central sensitization specifically related to input from Ad-fiber nociceptors. In addition, this paper describes an improved method of conducting nerve block studies on human volunteers.

    Article  PubMed  Google Scholar 

  27. LaMotte RH, Shain CN, Simone DA, Tsai E-FP: Neurogenic hyperalgesia: psychophysical studies of underlying mechanisms. J Neurophysiol 1991, 66:190–211.

    PubMed  CAS  Google Scholar 

  28. Cline MA, Ochoa J, Torebjörk HE: Chronic hyperalgesia and skin warming caused by sensitized C nociceptors. Brain 1989, 112:621–647.

    Article  PubMed  Google Scholar 

  29. Ochoa JL, Serra J, Campero M: Pathophysiology of human nociceptor function. In Neurobiology of Nociceptors. Edited by Belmonte C, Cervero F. Oxford: Oxford University Press; 1996:489–516.

    Google Scholar 

  30. Ochoa JL, Yarnitsky D: Mechanical hyperalgesias in neuropathic pain patients: dynamic and static subtypes. Ann Neurol 1993, 33:465–472.

    Article  PubMed  CAS  Google Scholar 

  31. Gracely RH, Lynch SA, Bennett GJ: Painful neuropathy: altered central processing maintained dynamically by peripheral input. Pain 1992, 51:175–194.

    Article  PubMed  CAS  Google Scholar 

  32. Rowbotham MC, Fields HL: The relationship of pain, allodynia and thermal sensation in post-herpetic neuralgia. Brain 1996, 119:347–354.

    Article  PubMed  Google Scholar 

  33. Baron R, Maier C: Painful neuropathy: C-nociceptor activity may not be necessary to maintain central mechanisms accounting for dynamic mechanical allodynia. Clin J Pain 1995, 11:63–69.

    Article  PubMed  CAS  Google Scholar 

  34. Baron R, Saguer M: Postherpetic neuralgia. Are C-nociceptors involved in signalling and maintenance of tactile allodynia? Brain 1993, 116:1477–1496.

    Article  PubMed  Google Scholar 

  35. Sieweke N, Birklein F, Riedl B, et al.: Patterns of hyperalgesia in complex regional pain syndrome. Pain 1999, 80:171–177. A very good example of how QST can be used in a neuropathic pain population to differentiate hyperalgesia caused by peripheral sensitization versus central sensitization.

    Article  PubMed  CAS  Google Scholar 

  36. Ochoa JL, Yarnitsky D: The triple cold syndrome. Cold hyperalgesia, cold hypoaesthesia and cold skin in peripheral nerve disease. Brain 1994, 117:185–197.

    Article  PubMed  Google Scholar 

  37. Craig AD: A new version of the thalamic disinhibition hypothesis of central pain. Pain Forum 1998, 7:1–14.

    Google Scholar 

  38. Verdugo R, Ochoa JL: Quantitative somatosensory thermotest. A key method for functional evaluation of small calibre afferent channels. Brain 1992, 115:893–913.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Oral and Craniofacial Biological Sciences, Room 5-A-12, University of Maryland Dental School, 666 W. Baltimore Street, 21201, Baltimore, MD, USA

    Joel D. Greenspan PhD

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  1. Joel D. Greenspan PhD
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Greenspan, J.D. Quantitative assessment of neuropathic pain. Current Science Inc 5, 107–113 (2001). https://doi.org/10.1007/s11916-001-0078-y

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  • DOI: https://doi.org/10.1007/s11916-001-0078-y

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