Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes

Maier, C.; Baron, R.; Tölle, T.R.; Binder, A.; Birbaumer, N.; Birklein, F.; Gierthmühlen, J.; Flor, H.; Geber, C.; Huge, V.; Krumova, E.K.; Landwehrmeyer, G.B.; Magerl, W.; Maihöfner, C.; Richter, H.; Rolke, R.; Scherens, A.; Schwarz, A.; Sommer, C.; Tronnier, V.; Üçeyler, N.; Valet, M.; Wasner, G.; Treede, R.-D.

doi:10.1016/j.pain.2010.05.002

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Volume 150, Issue 3 , Pages 439-450, September 2010

Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes

C. Maier
- Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
- Corresponding author. Address: Deutscher Forschungsverbund Neuropathischer Schmerz (DFNS), c/o Prof. Dr. Christoph Maier, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University, Bochum, Bürkle-de-la-Camp-Platz 1, D 44789 Bochum, Germany.
- DFNS steering committee.
- These authors equally contributed to this work.
R. Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DFNS steering committee.
- These authors equally contributed to this work.
T.R. Tölle
- Department of Neurology, Technische Universität, München, Germany
- DFNS steering committee.
A. Binder
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
N. Birbaumer
- Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Germany
F. Birklein
- Department of Neurology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany
J. Gierthmühlen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
H. Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute for Mental Health, Ruprecht-Karls-University, Heidelberg, Germany
C. Geber
- Department of Neurology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany
V. Huge
- Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany
E.K. Krumova
- Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
G.B. Landwehrmeyer
- Department of Neurology, University of Ulm, Germany
W. Magerl
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
C. Maihöfner
- Institute of Physiology and Experimental Pathophysiology, University of Erlangen, Germany
H. Richter
- Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
R. Rolke
- Department of Neurology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany
A. Scherens
- Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
A. Schwarz
- Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Germany
C. Sommer
- Department of Neurology, University of Würzburg, Germany
V. Tronnier
- Department of Neurosurgery, University Campus Lübeck, Germany
N. Üçeyler
- Department of Neurology, University of Würzburg, Germany
M. Valet
- Department of Neurology, Technische Universität, München, Germany
G. Wasner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
R.-D. Treede
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
- DFNS steering committee.
- These authors equally contributed to this work.

Received 13 November 2009; received in revised form 13 April 2010; accepted 5 May 2010. published online 07 June 2010.

Abstract

Neuropathic pain is accompanied by both positive and negative sensory signs. To explore the spectrum of sensory abnormalities, 1236 patients with a clinical diagnosis of neuropathic pain were assessed by quantitative sensory testing (QST) following the protocol of DFNS (German Research Network on Neuropathic Pain), using both thermal and mechanical nociceptive as well as non-nociceptive stimuli.

Data distributions showed a systematic shift to hyperalgesia for nociceptive, and to hypoesthesia for non-nociceptive parameters. Across all parameters, 92% of the patients presented at least one abnormality. Thermosensory or mechanical hypoesthesia (up to 41%) was more frequent than hypoalgesia (up to 18% for mechanical stimuli). Mechanical hyperalgesias occurred more often (blunt pressure: 36%, pinprick: 29%) than thermal hyperalgesias (cold: 19%, heat: 24%), dynamic mechanical allodynia (20%), paradoxical heat sensations (18%) or enhanced wind-up (13%). Hyperesthesia was less than 5%. Every single sensory abnormality occurred in each neurological syndrome, but with different frequencies: thermal and mechanical hyperalgesias were most frequent in complex regional pain syndrome and peripheral nerve injury, allodynia in postherpetic neuralgia. In postherpetic neuralgia and in central pain, subgroups showed either mechanical hyperalgesia or mechanical hypoalgesia. The most frequent combinations of gain and loss were mixed thermal/mechanical loss without hyperalgesia (central pain and polyneuropathy), mixed loss with mechanical hyperalgesia in peripheral neuropathies, mechanical hyperalgesia without any loss in trigeminal neuralgia.

Thus, somatosensory profiles with different combinations of loss and gain are shared across the major neuropathic pain syndromes. The characterization of underlying mechanisms will be needed to make a mechanism-based classification feasible.

Keywords: Quantitative sensory testing, Neuropathic pain, Somatosensory profile, Allodynia, Hyperalgesia, Hypoesthesia

Abbreviations: CDT, cold detection threshold, CPT, cold pain threshold, DFNS, Deutscher Forschungsverbund Neuropathischer Schmerz=German Research Network on Neuropathic Pain, DMA, dynamic mechanical allodynia, HPT, heat pain threshold, MDT, mechanical detection threshold, MPS, mechanical pain sensitivity, MPT, mechanical pain threshold, PHS, paradoxical heat sensation, PPT, pressure pain threshold, QST, quantitative sensory testing, TSL, thermal sensory limen, VDT, vibration detection threshold, WDT, warm detection threshold, WUR, wind-up ratio