Quantitative sensory testing (QST) provides an objective measure of pain perception through mechanical and thermal threshold assessment, which is used to clinically assess pain sensitivity and/or sensory dysfunction. 1 The effects of STN DBS on sensory thresholds are varied; 12 , 26 , 46 , 52 however, a study of 25 PD patients has suggested that high-frequency stimulation (HFS) increases mechanical and thermal pain thresholds. 26 , 37 , 53 Moreover, a recent study in 6OHDA (6-hydroxydopamine)–lesioned rats has suggested that both HFS and low-frequency stimulation (LFS) of
Abigail Belasen, Khizer Rizvi, Lucy E. Gee, Philip Yeung, Julia Prusik, Adolfo Ramirez-Zamora, Era Hanspal, Priscilla Paiva, Jennifer Durphy, Charles E. Argoff, and Julie G. Pilitsis
Michelle Cristina Ichida, Antonio Nogueira de Almeida, Jose Claudio Marinho da Nobrega, Manoel Jacobsen Teixeira, José Tadeu Tesseroli de Siqueira, and Silvia R. D. T. de Siqueira
limitations, and clinical dysfunction of and complaints about the masticatory function. The final tool used was quantitative sensory testing. All participants in the study underwent a standardized protocol of quantitative sensory testing, which consists of tests grouped as follows: 11 gustative and olfactory thresholds, thermal detection thresholds for cold and warm sensations, mechanical detection thresholds for touch and vibration perception, and mechanical pain sensitivity, including superficial and deep pain thresholds. The facial areas evaluated were the 3
Chang-Chia Liu, Shayan Moosa, Mark Quigg, and W. Jeffrey Elias
in case 6. Data are summarized using the mean ± 95% confidence level. Assessments of Heat Pain Threshold and Pain-Related Neurophysiology Analysis Heat pain threshold was assessed with a computerized quantitative sensory testing system—a psychophysical method that uses a thermal probe (i.e., 3 × 3–cm thermode, TSA-II Quantitative NeuroSensory Analyzer; Medoc Ltd.) placed on the subject's volar forearm, contralateral to the side of brain stimulation. This thermode was programmed to increase in temperature at a rate of 1°C per second from a baseline
Maxwell Boakye, Susan Harkema, Peter H. Ellaway, and Andrea C. Skelly
inclusion as quantitative measures: SSEPs, MEPs, dermatomal SSEPs, contact heat-evoked potentials, quantitative sensory testing (EPT, TPT, and VPT), and autonomic measures (sudomotor/quantitative sudomotor axon reflex test, sympathetic skin response, postural challenge/“tilt test,” Valsalva maneuver, sweating/thermoregulation sweating, and cardiovagal heart rate). The systematic search of PubMed combined terms related to traumatic SCI described above with those related to studies of reliability or validity [(Reproducibility of Results[MeSH] OR reliab*[TI] OR valid* OR
Dirk De Ridder, Guy Hans, Philippe Pals, and Tomas Menovsky
pain are resistant to itch and vice versa. 13 Thus, it can be hypothesized that if similar genetic predispositions exist in humans, this could explain why patients with brachioradial pruritus might only perceive itch and no pain and that both the genetic profile, the amount and selectivity of the nerve compression as well as the sex will determine whether C- and Aδ-fiber activation results in either pain or itch perception. Quantitative sensory testing refers to a group of protocols that allows for quantitative measures of somesthetic function. It has to be
Jean Régis, Philippe Metellus, Motohiro Hayashi, Philippe Roussel, Anne Donnet, and Françoise Bille-Turc
secondary objectives were to estimate changes in intensity of pain attacks, measure the mean number of pain attacks per day, and conduct neurological examinations and quantitative sensory testing for objective evaluation of changes in sensory perception. We also collected data on safety, quality of life, and patient satisfaction. The study was designed as an open, noncomparative prospective study with a within-subjects design. Ethics committee (CPPRB1) permission was obtained. The study was conducted under the supervision of the health authorities. Any severe adverse
Thomas Carlstedt, V. Peter Misra, Anastasia Papadaki, Donald McRobbie, and Praveen Anand
Motor but not sensory function has been described after spinal cord surgery in patients with brachial plexus avulsion injury. In the featured case, motor-related nerve roots as well as sensory spinal nerves distal to the dorsal root ganglion were reconnected to neurons in the ventral and dorsal horns of the spinal cord by implanting nerve grafts. Peripheral and sensory functions were assessed 10 years after an accident and subsequent spinal cord surgery. The biceps stretch reflex could be elicited, and electrophysiological testing demonstrated a Hoffman reflex, or Hreflex, in the biceps muscle when the musculocutaneous nerve was stimulated. Functional MR imaging demonstrated sensory motor cortex activities on active as well as passive elbow flexion. Quantitative sensory testing and contact heat evoked potential stimulation did not detect any cutaneous sensory function, however. To the best of the authors' knowledge, this case represents the first time that spinal cord surgery could restore not only motor function but also proprioception completing a spinal reflex arch.
Kim J. Burchiel, Timothy J. Johans, and Jose Ochoa
✓ Pain following suspected nerve injury was comprehensively evaluated with detailed examination including history', neurological evaluation, electrodiagnostic studies, quantitative sensory testing, thermography, anesthetic agents, and sympathetic nerve blocks. Forty-two surgically treated patients fell into four discrete groups: Group 1 patients had distal sensory neuromas treated by excision of the neuroma and reimplantation of the proximal nerve into muscle or bone marrow; Group 2 patients had suspected distal sensory neuromas in which the involved nerve was sectioned proximal to the injury site and reimplanted; Group 3 patients had proximal in-continuity neuromas of major sensorimotor nerves treated by external neurolysis; and Group 4 patients had proximal major sensorimotor nerve injuries at points of anatomical entrapment treated by external neurolysis and transposition, if possible. Patient follow-up monitoring from 2 to 32 months (average 11 months) was possible in 40 (95%) of 42 patients. Surgical success was defined as 50% or greater improvement in pain using the Visual Analog Scale or pain relief subjectively rated as either good or excellent, without postoperative narcotic usage. Overall, 16 (40%) of 40 patients met those criteria. Success rates varied as follows: 44% in 18 Group 1 patients, 40% in 10 Group 2 patients, 0% in five Group 3 patients, and 57% in seven Group 4 patients. Twelve (30%) of 40 patients were employed both pre- and postoperatively.
It is concluded that: 1) neuroma excision, neurectomy, and nerve release for injury-related pain of peripheral nerve origin yield substantial subjective improvement in a minority of patients; 2) external neurolysis of proximal mixed nerves is ineffective in relieving pain; 3) surgically proving the existence of a neuroma with confirmed excision may be preferable; 4) traumatic neuroma pain is only partly due to a peripheral source; 5) demographic and neurological variables do not predict success; 6) the presence of a discrete nerve syndrome and mechanical hyperalgesia modestly predict pain relief; 7) ongoing litigation is the strongest predictor of failure; and 8) change in work status is not a likely outcome.
collected with certainty and blindly, and the investigators analyzed and discussed the results accordingly. In their paper, one might have looked for the subheading on the study's limitations; however, it was missing. This section might have included mention of the following: 1) Preoperative American Society of Anesthesiologists (ASA) grading and the analgesic/narcotic utility of the cases are not identified. 1 , 2 , 6 2) Functional, psychological, and quantitative sensory testing has not been assessed in the included cases, nor has medical management of pain, depression