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For more information, please refer to our Privacy Policy. Subscribe to eTOC. Journal Logo. Advanced Search. Toggle navigation. Subscribe Register Login. Reese NB. A thermal sensory limen procedure TSL was performed in between to determine the paradoxical heat sensations PHS for alternating cold and warm stimuli. It should be emphasized that alterations in QST were also identified in non-neuropathic pain conditions, such as rheumatoid arthritis, inflammatory arthromyalgias and fibromyalgia [ 8 - 10 ].

1. INTRODUCTION

QST has not been widely used in patients with orofacial pain conditions and it may be of value to test this tool for the assessment of orofacial pain. Therefore, the aim of the study was to evaluate responses to thermal stimuli in subjects with orofacial pain, specifically the response between painful and non-painful facial sites, according to the German Research Network on neuropathic pain. Pain is supposed to be chronic i. Of these 60 subjects fifty were female mean age Subjects were excluded if they had a history of psychiatric or another illness in which medications e.

This device is controlled by designated software that can produce repeatable thermal stimuli [ 11 , 12 ]. The study followed the protocol of the German Research Network DFNS [ 5 ], using the methods of limits [ 12 ] and testing four modalities of thermal thresholds:. Cold induced pain — to assess a combination of both C and A-delta fibre mediated response. In the method of limits, the intensity of stimulus changes until it is halted by the patient when the required sensation is felt.

The thermode temperature then returns to the adaptation temperature for the next stimulus. Each participant was given a brief demonstration and instructed to remain still and hold the Thermode 1. The test starts when the temperature control unit achieves the requested temperature baseline temperature initially determined by the investigator. The cold-induced pain CP and heat-induced pain HP rate of temperature change was set at 1.

The interval between stimuli from the end of one stimulus to the onset of the next stimulus was set at sec. As soon as they pressed the mouse, the Thermode temperature immediately returned to the baseline temperature for the next stimulus. Four different clusters of stimuli were given, with five stimuli in each cluster a maximum of 20 stimuli in a test. The whole or part of the test was repeated if the participant inadvertently pressed the key too early or too late.

The 60 participants were diagnosed with different types of pain conditions and they were all grouped together as unilateral orofacial pain patients. A total of 18 trials were recorded on each side of the face. The mean value of the set of experiments for each modality CS, WS, CP, and HP was then calculated and a single t test statistical analysis was performed, where a p value of less than 0. The test results were compared to the results collected from the unaffected side of the same patient on the same area on the other control side of the face.

Differences in the test results between one side of the face and the other may indicate peripheral nerve disease or injury. Means and Standard Deviations of all scores of test for unilateral orofacial pain patients. This study has shown that participants with unilateral orofacial pain exhibited dysfunction of thermal processing on the pain side compared to the non-pain side.


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These findings are similar to other studies that have used QST and showed disruption of thermal processing in patients with different types of chronic pain conditions [ 13 - 18 ]. For instance, Launtenbachter and colleagues [ 14 ] tested thermal perception in 26 female patients with fibromyalgia. They compared their results within patients, between pain sites and non-pain sites, and with controls. Similar to our study, they found significant differences in pain patients between the pain site and the non-pain site. Also, there were significant differences in thermal perception between both sites and mirror sides in non-pain volunteers.

Kosek and Orderberg [ 17 ] performed a QST study on patients with osteoarthritis affecting their hips and they also found significant alteration of thermal sensitivity in their results. Ochoa and coworkers [ 18 ] found that thermal sensations were abnormal in all their neuropathic pain patients.

Similarly, in their two studies using same QST protocol in patients with fibromyalgia, Kosek and coworkers [ 15 , 16 ] found alteration of thermal perception in these patients. These findings support our results and suggest that patients with varying conditions of chronic pain exhibited dysfunction in thermal perception when tested with QST methods. However, in their comprehensive QST study on patients with neuropathic pain, Rolke and coworkers [ 7 ] found differences in thermal thresholds across the body regions for the same parameters i.

They recommended that QST results have to be compared between similar body regions. QST has been shown to be useful for a wide range of clinical conditions including chronic musculoskeletal pain [ 19 , 23 ].

QST pressure pain sensitivity test may play a role in outcome measures of pain and disability in patients with chronic neck pain [ 69 ]. A recent consensus from the IASP expert panel [ 60 ], reported that QST is capable of providing important and unique information from the somatosensory system, which would be valuable in assessment of patients with pain. Although there is emerging evidence that suggests a role for QST in pain management, the evidence to direct the specific modalities, techniques, diagnostic, or therapeutic prediction rules is lacking in many respects.

There is a need to continue testing to develop reliable and clinically feasible QST protocols that require less time and inexpensive portable equipment. For example, the current perception threshold test [ 55 , 62 ] has similar reliability to other less costly tests such as Semmes Weinstein Monofilaments test moderate cost [ 63 , 75 ], ice-water immersion test low cost [ 54 , 59 ], or the ten test no cost [ 54 , 58 , 76 ].

Head to head comparisons of these tests as screening, diagnostic, or evaluative tools will be needed to determine which tests provide better reliability and validity. Future research should also focus on longitudinal prospective studies with a large cohort of patients to justify the prognostic and evaluative properties of different sensory modalities; and to compare different sensory modalities, assessment protocols, indicators, and decision rules.

There is a need to develop and test clinical decision rules that include QST and other relevant factors to allow clinicians to classify patients needing different treatment approaches based on the pain typology; and trials to assess the efficacy of these decision rules. Since QST is not used consistently [ 77 ], there is a need for a knowledge translation strategy [ 61 ] to facilitate implementation of QST in clinical research and practice. The evidence supports the ability of QST to assess processing of sensory and pain perceptions although the strength of the relationship between optimized QST and pain outcomes requires further study before we can be confident these assessments can lead to better outcomes.

Clinicians have to choose from a variety of test modalities and methods, although there is insufficient evidence to select between current options. Tests of threshold detection are readily available and used in current practice, but stimulus intensity rating testing may be useful for evaluating patient change over time [ 78 ].

Many test protocols have been described with moderate to high reliability; but there are insufficient head-to-head comparisons to select the best QST.

Quantitative Sensory Testing in Chronic Musculoskeletal Pain | Pain Medicine | Oxford Academic

Variable effect sizes for associations and discriminative accuracy have been reported. QST may provide a semi-subjective method for examining sensation as a means of recognizing potential changes in the nociceptive pathways or it may help clarify vague or conflicting findings in clinical examination.

Coordination and joint position sense

QST might be a useful tool in determining pathogenesis, classification, differential diagnosis, prognosis, clinical outcome measures, or efficacy of treatment. Due to the diverse etiopathogenetic basis of musculoskeletal pain disorders, a broad range of reliable and valid QST measures are necessary to analyze the various disease entities. The evidentiary basis is currently sparse and does not provide sufficient information about which sensory modalities, test procedures, and decision rules are best to use QST as a diagnostic and evaluative tool.

QST may play a role in monitoring the disease prognosis and outcome evaluation in therapy intervention, but only continued research within homogenous parameters of QST will define this role. Joy C. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

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Introduction

Close mobile search navigation Article Navigation. Volume Article Contents. QST Measurement Principles. Oxford Academic. Google Scholar. Article history. Revision Received:. PDF Views. Cite Citation. Permissions Icon Permissions. Abstract Background. Figure 1. View large Download slide. Table 1. An example of stimulus modalities and pain measurement parameters in QST.

View Large. Table 2. Figure 2. Basal pain sensitivity and abnormal pain response detection. Figure 3.

Muscle and Sensory Testing

Table 3. Figure 4.


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