Quantitative sensory testing measures individual pain responses in emergency department patients

Duffy, Kevin J.; Flickinger, Katharyn L; Kristan, Jeffrey; Repine, Melissa; Gianforcaro, Alexandro; Hasley, Rebecca B.; Feroz, Saad; Rupp, Jessica M; Al-Baghli, Jumana; Pacella, Maria L.; Suffoletto, Brian; Callaway, Clifton W.

doi:10.2147/jpr.s132485

Cited by 7 publications

(3 citation statements)

References 49 publications

(56 reference statements)

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“…Comparison of patient sex between the two treatment groups was performed using Fisher's exact test. To account for variation in sensitivity between individuals, 7,32,33 the 5 values for each test site, testing instrument, and test day were averaged. These averages were then subtracted from the patient's corresponding baseline (Day 0) values to establish changes from baseline for each patient.…”

Section: Methodsmentioning

confidence: 99%

Glaucoma‐associated pain results in mechanical sensitivity changes in dogs: A pilot study

Zibura

Salmon

Lopez

et al. 2020

Veterinary Ophthalmology

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Purpose To explore the effects of chronic, uncontrolled glaucoma on pressure sensitivity in dogs before and after enucleation of the painful globe. Methods Client‐owned dogs undergoing enucleation for chronic glaucoma with no other sources of pain were enrolled. Normal dogs of similar breeds and skull morphology were enrolled as controls. Craniofacial ratio (CFR) and relative palpebral fissure width (RPFW) were assessed in all patients. Serial mechanical quantitative sensory testing (QST) was performed the day before surgery, and 14, 30, 60, and 120 days after surgery. QST consisted of electronic Von Frey (eVF), and blunt algometry (BA) performed above and below the nonglaucomatous eye, the metacarpus, and metatarsus. Cochet‐Bonnet esthesiometry (CB) was also performed on the remaining eye. Results Twelve dogs (6 per group) were included. Compared to baseline values, sensitivity tended to decrease over time (increased thresholds) in treatment dogs while it stayed constant or increased slightly in control dogs. The difference in change from baseline sensitivity between control and treatment groups was significant at day 120 using BA at supraorbital (P = .0153), infraorbital (P = .0209), and metacarpal sites (P = .007) and overall (P = .0470). This divergence was also significant using CB (P = .0470) on the opposite cornea. As patient CFR and RPFWV increased, both eVF (P = .005‐.023) and BA (P = .004‐.041) increased. Conclusions Sensitivity to mechanical stimuli decreased both locally and at remote sites in dogs following enucleation for painful chronic glaucoma. Cranial conformation is associated with differences in sensitivity.

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Section: Methodsmentioning

confidence: 99%

Glaucoma‐associated pain results in mechanical sensitivity changes in dogs: A pilot study

Zibura

Salmon

Lopez

et al. 2020

Veterinary Ophthalmology

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“…While minimizing observer bias by testing hyperekplexia patients and healthy controls by different investigators, this might have introduced inter-observer variability to the quantitative sensory test measurements. However, several studies have consistently reported satisfactory to excellent inter-observer reliability of quantitative sensory test measures, when performed in a standardized setting by trained investigators (Geber et al, 2011;Nikolajsen et al, 2011;Dyck et al, 2014;O'Neill and O'Neill, 2015;Boland-Freitas et al, 2016;Duffy et al, 2017).…”

Section: Strength and Limitationsmentioning

confidence: 99%

Mutations affecting glycinergic neurotransmission in hyperekplexia increase pain sensitivity

Vuilleumier

Fritsche

Schliessbach

et al. 2017

Brain

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See Dickenson (doi:10.1093/brain/awx334) for a scientific commentary on this article.Inhibitory interneurons in the spinal cord use glycine and GABA for fast inhibitory neurotransmission. While there is abundant research on these inhibitory pain pathways in animal models, their relevance in humans remains unclear, largely due to the limited possibility to manipulate selectively these pathways in humans. Hyperekplexia is a rare human disease that is caused by loss-of-function mutations in genes encoding for glycine receptors and glycine transporters. In the present study, we tested whether hyperekplexia patients display altered pain perception or central pain modulation compared with healthy subjects. Seven patients with genetically and clinically confirmed hyperekplexia were compared to 14 healthy age- and sex-matched controls. The following quantitative sensory tests were performed: pressure pain detection threshold (primary outcome), ice water tolerance, single and repeated electrical pain detection thresholds, nociceptive withdrawal reflex threshold, and conditioned pain modulation. Statistical analysis was performed using linear mixed models. Hyperekplexia patients displayed lower pain thresholds than healthy controls for all of the quantitative sensory tests [mean (standard deviation)]: pressure pain detection threshold [273 (170) versus 475 (115) kPa, P = 0.003], ice water tolerance [49.2 (36.5) versus 85.7 (35.0) s, P = 0.015], electrical single pain detection threshold [5.42 (2.64) versus 7.47 (2.62) mA, P = 0.012], electrical repeated pain detection threshold [3.76 (1.41) versus 5.8 (1.73) mA, P = 0.003], and nociceptive withdrawal reflex [7.42 (3.63) versus 14.1 (6.9) mA, P = 0.015]. Conditioned pain modulation was significantly reduced in hyperekplexia [increase to baseline: 53.2 (63.7) versus 105 (57) kPa, P = 0.030]. Our data demonstrate increased pain sensitivity and impaired central pain modulation in hyperekplexia patients, supporting the importance of glycinergic neurotransmission for central pain modulation in humans.

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“…Quantitative sensory testing is a validated experimental model of acute pain, and has been used in the development of novel analgesic agents 18 . Quantitative sensory testing includes standardized acute exposures to hot or cold temperatures as well as pressure algometry applied to the skin, and correlates with acute opioid pain relief achieved during clinical treatment in the emergency room 19 and post-operatively 20 . However, quantitative sensory testing has rarely been used to examine analgesic response in patients with opioid use disorder 21 , 22 .…”

Section: Introductionmentioning

confidence: 99%

Analgesic Effects of Hydromorphone versus Buprenorphine in Buprenorphine-maintained Individuals

et al. 2019

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EDITOR’S PERSPECTIVE What We Already Know about This Topic The prevalence of patients prescribed buprenorphine for treatment of opioid use disorder is increasing Managing acute pain in buprenorphine-maintained individuals can be challenging What This Article Tells Us That Is New Large doses of intravenous hydromorphone can provide analgesia in buprenorphine-maintained individuals However, the use of hydromorphone for analgesia in buprenorphine-maintained individuals confers greater abuse liability and side effects than does supplemental intravenous buprenorphine Background Managing acute pain in buprenorphine-maintained individuals in emergency or perioperative settings is a significant challenge. This study compared analgesic and abuse liability effects of adjunct hydromorphone and buprenorphine using quantitative sensory testing, a model of acute clinical pain, in persons maintained on 12 to 16 mg sublingual buprenorphine/naloxone. Methods Participants (N = 13) were enrolled in a randomized within-subject, double-blind, placebo-controlled three-session experiment. Each session used a cumulative dosing design with four IV injections (4, 4, 8, and 16 mg of hydromorphone or 4, 4, 8, and 16 mg of buprenorphine); quantitative sensory testing and abuse liability assessments were measured at baseline and after each injection. The primary analgesia outcome was change from baseline cold pressor testing; secondary outcomes included thermal and pressure pain testing, as well as subjective drug effects and adverse events. Results A significant two-way interaction between study drug condition and dose was exhibited in cold pressor threshold (F10,110 = 2.14, P = 0.027) and tolerance (F10,110 = 2.69, P = 0.006). Compared to after placebo, participants displayed increased cold pressor threshold from baseline after cumulative doses of 32 mg of IV hydromorphone (means ± SD) (10 ± 14 s, P = 0.035) and 32 mg of buprenorphine (3 ± 5 s, P = 0.0.39) and in cold pressor tolerance after cumulative doses of 16 mg (18 ± 24 s, P = 0.018) and 32 mg (48 ± 73 s, P = 0.041) IV hydromorphone; cold pressor tolerance scores were not significant for 16 mg (1 ± 15 s, P = 0.619) or 32 mg (7 ± 16 s, P = 0.066) buprenorphine. Hydromorphone and buprenorphine compared with placebo showed greater ratings on subjective measures of high, any drug effects, good effects, and drug liking. Adverse events were more frequent during the hydromorphone compared with buprenorphine and placebo conditions for nausea, pruritus, sedation, and vomiting. Conclusions In this acute clinical pain model, high doses of IV hydromorphone (16 to 32 mg) were most effective in achieving analgesia but also displayed higher abuse liability and more frequent adverse events. Cold pressor testing was the most consistent measure of opioid-related analgesia.

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Quantitative sensory testing measures individual pain responses in emergency department patients

Cited by 7 publications

References 49 publications

Glaucoma‐associated pain results in mechanical sensitivity changes in dogs: A pilot study

Glaucoma‐associated pain results in mechanical sensitivity changes in dogs: A pilot study

Mutations affecting glycinergic neurotransmission in hyperekplexia increase pain sensitivity

Analgesic Effects of Hydromorphone versus Buprenorphine in Buprenorphine-maintained Individuals

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