PAIN
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

      Affiliations

    • Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
    • Corresponding Author InformationCorresponding 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

      Affiliations

    • 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

      Affiliations

    • Department of Neurology, Technische Universität, München, Germany
    • DFNS steering committee.
  • ,
  • A. Binder

      Affiliations

    • Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
  • ,
  • N. Birbaumer

      Affiliations

    • Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Germany
  • ,
  • F. Birklein

      Affiliations

    • Department of Neurology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany
  • ,
  • J. Gierthmühlen

      Affiliations

    • Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
  • ,
  • H. Flor

      Affiliations

    • Department of Cognitive and Clinical Neuroscience, Central Institute for Mental Health, Ruprecht-Karls-University, Heidelberg, Germany
  • ,
  • C. Geber

      Affiliations

    • Department of Neurology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany
  • ,
  • V. Huge

      Affiliations

    • Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany
  • ,
  • E.K. Krumova

      Affiliations

    • Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
  • ,
  • G.B. Landwehrmeyer

      Affiliations

    • Department of Neurology, University of Ulm, Germany
  • ,
  • W. Magerl

      Affiliations

    • Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
  • ,
  • C. Maihöfner

      Affiliations

    • Institute of Physiology and Experimental Pathophysiology, University of Erlangen, Germany
  • ,
  • H. Richter

      Affiliations

    • Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
  • ,
  • R. Rolke

      Affiliations

    • Department of Neurology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany
  • ,
  • A. Scherens

      Affiliations

    • Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany
  • ,
  • A. Schwarz

      Affiliations

    • Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Germany
  • ,
  • C. Sommer

      Affiliations

    • Department of Neurology, University of Würzburg, Germany
  • ,
  • V. Tronnier

      Affiliations

    • Department of Neurosurgery, University Campus Lübeck, Germany
  • ,
  • N. Üçeyler

      Affiliations

    • Department of Neurology, University of Würzburg, Germany
  • ,
  • M. Valet

      Affiliations

    • Department of Neurology, Technische Universität, München, Germany
  • ,
  • G. Wasner

      Affiliations

    • Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
  • ,
  • R.-D. Treede

      Affiliations

    • 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 ,Revised 13 April 2010 ,Accepted 5 May 2010.

References 

  1. Abt K. Descriptive data analysis: a concept between confirmatory and exploratory data analysis. Methods Inf Med. 1987;26:77–88
  2. Agostinho CM, Scherens A, Richter H, Schaub C, Rolke R, Treede RD, et al. Habituation and short-term repeatability of thermal testing in healthy human subjects and patients with chronic non-neuropathic pain. Eur J Pain. 2009;13:779–785
  3. Amir R, Michaelis M, Devor M. Burst discharge in primary sensory neurons: triggered by subthreshold oscillations, maintained by depolarizing after potentials. J Neurosci. 2002;22:1187–1198
  4. Apkarian AV, Stea RA, Bolanowski SJ. Heat-induced pain diminishes vibrotactile perception: a touch gate. Somatosens Mot Res. 1994;11:259–267
  5. Attal N, Fermanian C, Fermanian J, Lanteri-Minet M, Alchaar H, Bouhassira D. Neuropathic pain: are there distinct subtypes depending on the aetiology or anatomical lesion?. Pain. 2008;138:343–353
  6. Baron R. Mechanisms of disease: neuropathic pain – a clinical perspective. Nat Clin Pract Neurol. 2006;2:95–106
  7. Baumgärtner U, Magerl W, Klein T, Hopf HC, Treede RD. Neurogenic hyperalgesia versus painful hypoalgesia: two distinct mechanisms of neuropathic pain. Pain. 2002;96:141–151
  8. Boivie J. Central pain and the role of quantitative sensory testing (QST) in research and diagnosis. Eur J Pain. 2003;7:339–343
  9. Bond M, Breivik H, Jensen TS, Scholten W, Soyannwo O, Treede RD. Pain associated with neurological disorders. In:  Aarli JA,  Dua T,  Janca A,  Muscetta A editor. Neurological disorders: public health challenges. Genf: WHO; 2006;p. 127–139
  10. Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, et al. External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. International Association for the Study of Pain. Pain. 1999;81:147–154
  11. Cruccu G, Leandri M, Iannetti GD, Mascia A, Romaniello A, Truini A, et al. Small-fiber dysfunction in trigeminal neuralgia – carbamazepine effect on laser-evoked potentials. Neurology. 2001;56:1722–1726
  12. Cruccu G, Truini A. Tools for assessing neuropathic pain. PLoS Med. 2009;6:e1000045
  13. Craig AD, Blomqvist A. Is there a specific lamina I spinothalamocortical pathway for pain and temperature sensations in primates?. J Pain. 2002;3:95–101
  14. England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodi-agnostic Medicine, and the American Academy of Physical Medicine and Re-habilitation. Neurology. 2005;64:199–207
  15. Fields HL, Rowbotham M, Baron R. Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiol Dis. 1998;5:209–227
  16. Geber C, Magerl W, Fondel R, Fechir M, Rolke R, Vogt T, et al. Numbness in clinical and experimental pain – a cross-sectional study exploring the mechanisms of reduced tactile function. Pain. 2008;139:73–81
  17. Geber C, Scherens A, Pfau D, Nestler N, Zenz M, Tölle T, et al. Procedure for certification of QST laboratories. Schmerz. 2009;23:65–69
  18. Gockel HH, Maier C. Computer-assisted tool (QUAST) for documentation and quality assurance in pain treatment. Schmerz. 2000;14:401–415
  19. Greenspan JD, Ohara S, Sarlani E, Lenz FA. Allodynia in patients with post-stroke central pain (CPSP) studied by statistical quantitative sensory testing within individuals. Pain. 2004;109:357–366
  20. Haanpää ML, Backonja MM, Bennett MI, Bouhassira D, Cruccu G, Hansson PT, et al. Assessment of neuropathic pain in primary care. Am J Med. 2009;122:S13–21
  21. Hansen C, Hopf HC, Treede RD. Paradoxical heat sensation in patients with multiple sclerosis. Evidence for a supraspinal integration of temperature sensation. Brain. 1996;119:1729–1736
  22. Hansson P. Neuropathic pain: clinical characteristics and diagnostic workup. Eur J Pain. 2002;6:47–50
  23. Hansson PT, Attal N, Baron R, Cruccu G. Toward a definition of pharmacoresistant neuropathic pain. Eur J Pain. 2009;13:439–440
  24. Hansson P, Backonja M, Bouhassira D. Usefulness and limitations of quantitative sensory testing: clinical and research application in neuropathic pain states. Pain. 2007;129:256–259
  25. Harden RN, Bruehl SP. Diagnosis of complex regional pain syndrome: signs, symptoms, and new empirically derived diagnostic criteria. Clin J Pain. 2006;22:415–419
  26. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia. 2004;24(Suppl. 1):9–160
  27. Jensen TS, Baron R. Translation of symptoms and signs into mechanisms in neuropathic pain. Pain. 2003;102:1–8
  28. Johnson RW, Wasner G, Saddier P, Baron R. Herpes zoster and postherpetic neuralgia: optimizing management in the elderly patient. Drugs Aging. 2008;25:991–1006
  29. Katz J, Finnerup NB, Dworkin RH. Clinical trial outcome in neuropathic pain: relationship to study characteristics. Neurology. 2008;70:263–272
  30. Klauenberg S, Maier C, Assion HJ, Hoffmann A, Krumova E, Magerl W, et al. Depression and changed pain perception: hints for a central disinhibition mechanism. Pain. 2008;140:332–343
  31. Lang PM, Schober GM, Rolke R, Wagner S, Hilge R, Offenbächer M, et al. Sensory neuropathy and signs of central sensitization in patients with peripheral arterial disease. Pain. 2006;124:190–200
  32. Lenz FA, Kwan HC, Dostrovsky JO, Tasker RR. Characteristics of the bursting pattern of action potentials that occurs in the thalamus of patients with central pain. Brain Res. 1989;496:357–360
  33. Lienert GA, Krauth J. Configural frequency analysis as a statistical tool for defining types. Educ Psychol Meas. 1975;35:231–238
  34. Liu XG, Eschenfelder S, Blenk K-H, Jänig W, Häbler HJ. Spontaneous activity of axotomized afferent neurons after L5 spinal nerve injury in rats. Pain. 2000;84:309–318
  35. Lorenz J, Minoshima S, Casey KL. Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation. Brain. 2003;126:1079–1091
  36. Magerl W, Krumova EK, Baron R, Tölle T, Treede RD, Maier C. Technical note: reference data for quantitative sensory testing (QST): refined stratification for age and a novel method for statistical comparison of group data. MS D09-6235, submitted for publication.
  37. Magerl W, Treede RD. Secondary tactile hypoesthesia: a novel type of pain-induced somatosensory plasticity in human subjects. Neurosci Lett. 2004;361:136–139
  38. Noordenbos W. Pain. Amsterdam: Elsevier; 1959;
  39. Oaklander AL, Rissmiller JG, Gelman LB, Zheng L, Chang Y, Gott R. Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy). Pain. 2006;120:235–243
  40. Oaklander AL. The density of remaining nerve endings in human skin with and without postherpetic neuralgia after shingles. Pain. 2001;92:139–145
  41. Ochoa JL, Campero M, Serra J, Bostock H. Hyperexcitable polymodal and insensitive nociceptors in painful human neuropathy. Muscle Nerve. 2005;32:459–472
  42. Ørstavik K, Namer B, Schmidt R, Schmelz M, Hilliges M, Weidner C, et al. Abnormal function of C-fibers in patients with diabetic neuropathy. J Neurosci. 2006;26:11287–11294
  43. Petersen KL, Rowbotham MC. Quantitative sensory testing scaled up for multicenter clinical research networks: a promising start. Pain. 2006;123:219–220
  44. Price DD, Hu JW, Dubner R, Gracely RH. Peripheral suppression of first pain and central summation of second pain evoked by noxious heat pulses. Pain. 1977;3:57–68
  45. Rasmussen PV, Sindrup SH, Jensen TS, Bach FW. Symptoms and signs in patients with suspected neuropathic pain. Pain. 2004;110:461–469
  46. Rolke R, Baron R, Maier C, Tolle TR, Treede RD, Beyer A, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006;123:231–243
  47. 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;10:77–88
  48. Sandkühler J. Models and mechanisms of hyperalgesia and allodynia. Physiol Rev. 2009;89:707–758
  49. Scherens A, Maier C, Haussleiter IS, Schwenkreis P, Vlckova Moravcova E, Baron R, et al. Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities. Eur J Pain. 2009;13:711–718
  50. Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, Zheng H, et al. A novel tool for the assessment of pain: validation in low back pain. PLoS Med. 2009;6:e1000047
  51. Serra J, Solà R, Quiles C, Casanova-Molla J, Pascual V, Bostock H, et al. C-nociceptors sensitized to cold in a patient with small-fiber neuropathy and cold allodynia. Pain. 2009;147:46–53
  52. Simone DA, Sorkin LS, Oh U, Chung JM, Owens C, LaMotte RH, et al. Neurogenic hyperalgesia: central neural correlates in responses of spinothalamic tract neurons. J Neurophysiol. 1991;66:228–246
  53. Sinay VJ, Bonamico LH, Dubrovsky A. Subclinical sensory abnormalities in trigeminal neuralgia. Cephalalgia. 2003;23:541–544
  54. Treede RD, Baron R. How to detect a sensory abnormality. Eur J Pain. 2008;12:395–396
  55. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630–1635
  56. Treede RD, Meyer RA, Raja SN, Campbell JN. Peripheral and central mechanisms of cutaneous hyperalgesia. Prog Neurobiol. 1992;38:397–421
  57. Treede RD, Handwerker HO, Baumgärtner U, Meyer RA, Magerl W. Hyperalgesia and allodynia: taxonomy, assessment, and mechanisms. In:  Brune K,  Handwerker HO editor. Hyperalgesia: molecular mechanisms and clinical implications. vol. 30:Seattle: IASP Press; 2004;p. 1–15
  58. Truini A, Galeotti F, Haanpaa M, Zucchi R, Albanesi A, Biasiotta A, et al. Pathophysiology of pain in postherpetic neuralgia: a clinical and neurophysiological study. Pain. 2008;140:405–410
  59. Wasner G, Schattschneider J, Binder A, Baron R. Topical menthol – a human model for cold pain by activation and sensitization of C nociceptors. Brain. 2004;127:1159–1171
  60. Zhao P, Waxman SG, Hains BC. Sodium channel expression in the ventral posterolateral nucleus of the thalamus after peripheral nerve injury. Mol Pain. 2006;2:27–36

PII: S0304-3959(10)00272-1

doi: 10.1016/j.pain.2010.05.002

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