Sensory bedside testing: a simple stratification approach for sensory phenotyping

Abstract

Introduction: Stratification of patients according to the individual sensory phenotype has been suggested a promising method to identify responders for pain treatment. However, many state-of-the-art sensory testing procedures are expensive or time-consuming. Objectives: Therefore, this study aimed to present a selection of easy-to-use bedside devices. Methods: In total, 73 patients (39 m/34 f) and 20 controls (11 m/9 f) received a standardized laboratory quantitative sensory testing (QST) and a bedside-QST. In addition, 50 patients were tested by a group of nonexperienced investigators to address the impact of training. The sensitivity, specificity, and receiver-operating characteristics were analyzed for each bedside-QST parameter as compared to laboratory QST. Furthermore, the patients' individual sensory phenotype (ie, cluster) was determined using laboratory QST, to select bedside-QST parameters most indicative for a correct cluster allocation. Results: The bedside-QST parameters “loss of cold perception to 22°C metal,” “hypersensitivity towards 45°C metal,” “loss of tactile perception to Q-tip and 0.7 mm CMS hair,” as well as “the allodynia sum score” indicated good sensitivity and specificity (ie, ≳70%). Results of interrater variability indicated that training is necessary for individual parameters (ie, CMS 0.7). For the cluster assessment, the respective bedside quantitative sensory testing (QST) parameter combination indicated the following agreements as compared to laboratory QST stratification: excellent for “sensory loss” (area under the curve [AUC] = 0.91), good for “thermal hyperalgesia” (AUC = 0.83), and fair for “mechanical hyperalgesia” (AUC = 0.75). Conclusion: This study presents a selection of bedside parameters to identify the individual sensory phenotype as cost and time efficient as possible.

Modified Sensory Testing in Non-verbal Patients Receiving Novel Intrathecal Therapies for Neurological Disorders

“…Standardized protocols permit comparison of one individual to normative values and patients with neuropathic conditions using multicenter databases (5,6,14,(19)(20)(21)(22)(23). Patient stratification according to QST profile has been proposed to identify responders in analgesic trials (24). QST has been used in over 1,000 patients with malignancies to investigate large and small fiber neuropathies associated with chemotherapy agents, including bortezomib, vincristine, taxanes, and platinum compounds (25)(26)(27)(28).…”

Noziplastischer Schmerz

“…Auf diese wurde auch im Rahmen der physiotherapeutischen Praxis hingewiesen [41]. In diesem Zusammenhang sei betont, dass für die somatosensorische Prüfung bereits ein international breit akzeptierter Methodenkanon entwickelt und Referenztabellen erarbeitet wurden, die sowohl Verfahren mit hoher Präzision als auch einfachere Untersuchungstechniken wie die ‚Bedside QST' umfassen [42,43]. Eine Untersuchung muss sich an solchen Standardwerten orientieren, um nicht einfach ein willkürliches Urteil zu sein.…”

Understanding the Psychological, Physiological, and Genetic Factors Affecting Precision Pain Medicine: A Narrative Review

“…74 Attempts at simplifying QST batteries for administration in the clinical setting have been reported and have shown that a variety of simple bedside tools (ice cubes, pinprick, cotton swabs) can reliably be used to quantify numerous QST parameters. [75][76][77][78][79] Further research is warranted via large multi-center trials in order to investigate whether bedside QST batteries can predict response to and improve pharmacologically directed therapies.…”