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Using Quantitative Sensory Testing in Musculoskeletal Pain
Anushka Soni
Quantitative Sensory Testing can be considered as an extension of the neurological sensory examination. It was devised in order to identify sensory neural dysfunction and is also used to quantify sensory changes in patients with neuropathic pain. There are multiple forms of QST and a comprehensive protocol for testing has been compiled by Rolke et al ADDIN EN.CITE Rolke2006105[1]10510517Rolke, R.Magerl, W.Campbell, K. A.Schalber, C.Caspari, S.Birklein, F.Treede, R. D.Institute of Physiology and Pathophysiology, Johannes Gutenberg-University, Saarstr. 21, D-55099 Mainz, Germany.Quantitative sensory testing: a comprehensive protocol for clinical trialsEur J PainEur J Pain77-881012005/11/18AdultClinical ProtocolsClinical Trials as TopicFemaleHumansHyperalgesia/diagnosis/ physiopathologyMaleMiddle AgedPain Measurement/ methodsPain Threshold/ physiology/psychologyReproducibility of ResultsResearch Design2006Jan1090-3801 (Print)16291301S1090-3801(05)00027-3 [pii]
10.1016/j.ejpain.2005.02.003 [doi]eng[HYPERLINK \l "_ENREF_1" \o "Rolke, 2006 #105"1]. The main features of each test are that a controlled stimulus can be applied to a test area and that the subject response to this stimulus can also be measured. The equipment available enables us to test a variety of modalities including heat, cold, pressure and pin-prick. The same stimuli can be applied in different ways to measure different thresholds including detection thresholds, pain thresholds and sensitivity to supra-threshold stimuli.
We are beginning to appreciate that joint pain may be due to central and peripheral sensitization as well as direct joint pathology. In turn a mechanism based approach to diagnosis and management may improve patient outcome. Evidence of neuropathic features in musculoskeletal pain conditions comes from studies of QST measures ADDIN EN.CITE Wylde2011588[2]58858817Wylde, V.Palmer, S.Learmonth, I. D.Dieppe, P.Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Faculty of Health and Life Sciences, University of the West of England, Bristol and Institute of Clinical Education, Peninsula Medical School, Universities of Exeter and Plymouth, Plymouth, UK.Somatosensory abnormalities in knee OARheumatologyRheumatology (Oxford)RheumatologyRheumatology (Oxford)2011/11/292011Nov 241462-0332 (Electronic)
1462-0324 (Linking)22120461http://www.ncbi.nlm.nih.gov/pubmed/2212046110.1093/rheumatology/ker343Eng[HYPERLINK \l "_ENREF_2" \o "Wylde, 2011 #588"2] as well as symptom-based assessments ADDIN EN.CITE Hochman2011583[3]58358317Hochman, J. R.Gagliese, L.Davis, A. M.Hawker, G. A.Division of Rheumatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada. j.hochman@utoronto.caNeuropathic pain symptoms in a community knee OA cohortOsteoarthritis and cartilage / OARS, Osteoarthritis Research SocietyOsteoarthritis CartilageOsteoarthritis Cartilage647-541962011/03/29AgedAged, 80 and overCohort StudiesFemaleHumansMaleNeuralgiaOntario/epidemiologyOsteoarthritis, Knee/*complicationsPain/*diagnosis/epidemiologyPain Measurement/*methodsPrevalenceQuestionnaires/standardsReproducibility of ResultsSeverity of Illness Index2011Jun1522-9653 (Electronic)
1063-4584 (Linking)21440077Research Support, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/pubmed/2144007710.1016/j.joca.2011.03.007eng[HYPERLINK \l "_ENREF_3" \o "Hochman, 2011 #583"3] but little work has been done to investigate how these two methods of assessment relate to one another.
We have conducted a community-based study which was designed to describe the characteristics of joint pain as well as to examine the relationship between any features of neuropathic pain identified using QST and the PainDETECT questionnaire ADDIN EN.CITE Soni2013654[4]65465417Soni, A.Batra, R. N.Gwilym, S. E.Spector, T. D.Hart, D. J.Arden, N. K.Cooper, C.Tracey, I.Javaid, M. K.University of Oxford, Oxford, UK.Neuropathic features of joint pain: a community-based studyArthritis and rheumatismArthritis RheumArthritis and RheumatismArthritis Rheum1942-96572013/04/052013Jul1529-0131 (Electronic)
0004-3591 (Linking)23553508http://www.ncbi.nlm.nih.gov/pubmed/23553508370147710.1002/art.37962eng[HYPERLINK \l "_ENREF_4" \o "Soni, 2013 #654"4]. This study demonstrated that subjects with joint pain were more sensitive to all painful stimuli we tested using QST conducted at a central site away from any painful areas. Although the cutoffs for possible or likely neuropathic pain were only met in around 8% of the subjects, many demonstrated one or more features associated with neuropathic pain. Furthermore heat pain thresholds and mechanical pain sensitivity were significantly associated with the presence of possible or likely neuropathic pain, determined using the PainDETECT questionnaire. These results provide reassuring concurrent validation for both techniques and we are now investigating these tools in patients with osteoarthritis of the knee who are due to have knee replacement surgery.
ADDIN EN.REFLIST 1. Rolke R, Magerl W, Campbell KA, Schalber C, Caspari S, Birklein F, et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain 2006;10(1):77-88.
2. Wylde V, Palmer S, Learmonth ID, Dieppe P. Somatosensory abnormalities in knee OA. Rheumatology 2011.
3. Hochman JR, Gagliese L, Davis AM, Hawker GA. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 2011;19(6):647-54.
4. Soni A, Batra RN, Gwilym SE, Spector TD, Hart DJ, Arden NK, et al. Neuropathic features of joint pain: a community-based study. Arthritis and rheumatism 2013;65(7):1942-9.
Friday Programme Anushka Soni
Lecture Notes National Acute Pain Symposium September 2013
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