Quantitative Sensory Testing and Mapping of Neuropathic Pain

David Walk, MD

Associate Professor
Director, Neurology Clerkship
Medical Director, Clinical Neurophysiology Laboratory Primary
University of Minnesota
Minneapolis, MN

Relatively simply and repeatable methods to quantify the sensory features of neuropathic pain are of critical importance for research and would complement current neurologic, musculoskeletal, and physical exams in the clinical setting. Recent efforts have sought to develop quantitative sensory testing (QST) as a comprehensive bedside neuropathic pain examination technique for sensory mapping and identification of positive and negative signs with such modalities as mechanical, pressure, vibration, and thermal. The Neuropathic Pain Research Consortium recommends a combination of pain ratings, existing neuropathic pain questionnaires, sensory mapping, and threshold testing using readily available, relatively inexpensive tools. Results of a neurologic examination and QST evaluation help clinicians to clarify whether pain is neuropathic, monitor disease progression, and assess treatment response. In some cases, certain findings may reflect contributory mechanisms (eg, central sensitization, disinhibition of C-fiber input).

References

Walk D, Sehgal N, Moeller-Bertram T, et al. Quantitative sensory testing and mapping: a review of nonautomated quantitative methods for examination of the patient with neuropathic pain. Clin J Pain. 2009;25(7):632-640.
Rolke R, Magerl W, Campbell KA, et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006;10(1):77-88.
Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70(18):1630-1635.
Backonja MM, Krause SJ. Neuropathic pain questionnaire--short form. Clin J Pain. 2003;19(5):315-316.

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