Application of the monofilament cutaneous threshold test in assessing impaired touch sensation caused by central nervous system injury / 中华物理医学与康复杂志

Objective:To test the utility of monofilament cutaneous threshold testing among patients with impaired touch sensation caused by central nervous system injury.Methods:Thirty stroke survivors and 30 patients with spinal cord injury were recruited. Monofilament threshold testing and cotton wool tests were performed on the bilateral forehead, face, palms and dorsum of feet among the stroke survivors. Among those with a spinal cord injury both tests were performed on each side of the L 4, L 5 and S 1 vertebrae. One week later, all were retested. Intra-class correlation coefficients (ICCs) were used to quantify the test-retest reliability of the tests. Kappa values were calculated to determine the degree of agreement between them. Stepwise multiple linear regressions were evaluated to examine the relationship between touch perception thresholds and age, height, gender, type of injury and injured site. Results:①The ICC for the monofilament test was between 0.74 and 0.95, higher than that of the cotton wool test (ICC: 0.60 to 0.83). ②The kappa value between the monofilament and cotton wool tests was 0.550, indicating good agreement. ③The types of injury and injured sites were independent correlates of the touch perception thresholds, but there was no significant correlation between the touch perception thresholds and age, height, gender or group.Conclusions:The monofilament cutaneous threshold test has good test-retest reliability, better than the cotton wool test. Therefore, it may be useful as a tool for assessing impaired touch sensation caused by central nervous system injury.

Clinical Evaluation for Diabetic Neuropathy / 대한신경근육질환학회지

Diabetic polyneuropathy (DPN) causes neuropathic pain with reduced quality of life as well as diabetic foot ulceration which sometimes resulted in amputation. Early detection and improved knowledge of pathogenic pathways are important to prevent and to manage DPN. The screening methods and several tests to diagnose DPN-quantitative sensory testing, skin biopsy, corneal confocal microscopy, etc.-will be described.

Effect of 8% lidocaine spray on the sensory and pain thresholds of the skin of the face and hands evaluated by quantitative sensory testing

BACKGROUND: Recently, we examined the effects of 2% lidocaine gel on the tactile sensory and pain thresholds of the face, tongue and hands of symptom-free individuals using quantitative sensory testing (QST); its effect was less on the skin of the face and hands than on the tongue. Consequently, instead of 2% lidocaine gel, we examined the effect of 8% lidocaine spray on the tactile sensory and pain thresholds of the skin of the face and hands of healthy volunteers. METHODS: Using Semmes-Weinstein monofilaments, QST of the skin of the cheek and palm (thenar skin) was performed in 20 healthy volunteers. In each participant, two topical sprays were applied. On one side, 0.2 mL of 8% lidocaine pump spray was applied, and on the other side, 0.2 mL of saline pump spray was applied as control. In each participant, QST was performed before and 15 min after each application. Pain intensity was measured using a numeric rating scale (NRS). RESULTS: Both the tactile detection threshold and filament-prick pain detection threshold of the cheek and thenar skin increased significantly after lidocaine application. A significant difference between the effect of lidocaine and saline applications was found on the filament-prick pain detection threshold only. NRS of the cheek skin and thenar skin decreased after application of lidocaine, and not after application of saline. CONCLUSION: The significant effect of applying an 8% lidocaine spray on the sensory and pain thresholds of the skin of the face and hands can be objectively scored using QST.

Comparing and analyzing the application value of F wave in the use of electrophysiological examination of diabetic peripheral neuropathy / 中国医师进修杂志

Objective To evaluate the application value of F wave by comparison with quantitative sensory testing(QST)and nerve conduction studies(NCS)in diabetes peripheral neuropathy (DPN). Methods Three hundred and fourteen diabetic patients with symptom of DPN were retrospectively analyzed, who were recruited and divided into four groups according the course of diabetes mellitus: ≤ 3 years group, 4-6 years group, 7-9 years group and >9 years group. The abnormal rates of QST, NCS and F wave were analyzed and compared. Results At earlier course of disease (≤ 3 years group, 4- 6 years group), the abnormal rate of QST [76.54%(62/81), 91.67% (88/96)]>F wave[(48.15%(39/81),64.58%(62/96)]>NCS[(32.10%(26/81),47.92%(46/96)], and there were significant differences(P<0.01).The abnormal rate of QST, F wave and NCS at 7-9 years group and>9 years group had no significant differences(P>0.05).The abnormal rate of QST in 4-6 years group[(91.67%(88/96)]was higher than that in≤3 years group[(76.54%(62/81)],and decreased in 7-9 years group and >9 years group. The abnormal rate of NCS was increased with course of disease, and the range was obviously between close together group. The abnormal rate of F wave was increased with course of disease,but in 4-6 years group the range was obvious and the range was slow down.At earlier course of disease (≤3 years group, 4-6 years group), the abnormal rate of only F wave significantly increased the abnormal rate of NCS + F wave from 30.86%(25/81), 44.79% (43/96)to 46.91%(38/81), 61.46%(59/96)respectively, but in 7-9 years group and>9 years group, the abnormal rate of only F wave increased the abnormal rate of NCS + F wave from 69.44%(50/72), 84.61%(55/65)to 72.22% (52/72),86.15%(56/65).Conclusions Although the abnormal rate of F wave is not as high as QST, it is still remarkable. Detection of F wave shows positive correlations with the course of disease, which can reflect the course of disease objectively and reliably.The added F wave detection can distinctly raise the abnormal rates on the base of NCS.

Acupuncture treatment for idiopathic trigeminal neuralgia: A longitudinal case-control double blinded study / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the treatment effect of acupuncture on patients with idiopathic trigeminal neuralgia (ITN) by case-control longitudinal blinded study.</p><p><b>METHODS</b>Sixty ITN patients and 30 healthy subjects were included. The ITN patients were randomly assigned to acupuncture group (15 cases), sham-acupuncture group (15 cases) and carbamazepine group (30 cases), respectively. Clinical orofacial evaluation (including pain intensity and medication doses), research diagnostic criteria for temporomandibular disorders (RDC/TMD) and Helkimo indexes (for functional evaluation of the masticatory system), and quantitative sensory testing for sensory thresholds (gustative, olfactory, cold, warm, touch, vibration and superficial and deep pain) were evaluated before treatment, immediately after treatment, and 6 months after treatment.</p><p><b>RESULTS</b>The mean pain intensity by the Visual Analogue Scale only decreased in the acupuncture group at the last evaluation (P=0.012). Patients in the sham-acupuncture group had an increase in carbamazepine doses according to the prescriptions (P<0.01). There was a reduction in secondary myofascial pain and mandibular limitations at the acupuncture and sham-acupuncture groups, however only the acupuncture group kept the changes after 6 months (P<0.01, P=0.023). There was a decrease in mechanical thresholds in the acupuncture group (tactile, P<0.01; vibration, P=0.027) and an increase in deep pain thresholds in both acupuncture and sham-acupuncture groups (P=0.013).</p><p><b>CONCLUSIONS</b>Acupuncture can be an option in the treatment of ITN due to its analgesic effect in both ITN and secondary myofascial pain associated with it.</p>

Somatosensory, inflammatory and pain evaluation during orthodontic treatment / Avaliação das alterações dolorosas, inflamatórias e somatossensoriais em pacientes durante tratamento ortodôntico

Experimental tooth movement has been shown to induce inflammation and release of chemical mediators. Inflammation can also alter nerve function that can be measured with Quantitative Sensory Testing (QST). Various authors have studied orthodontic pain and the different factors that modify it. But, to our knowledge none studied a possible individual endogenous analgesia effect on orthodontic induced-pain. The aim of the present study was to investigate the impact of orthodontic separator and short-term fixed orthodontic appliance on the somatosensory function and gingival cervicular fluid (GCF) levels of IL-1ß, IL-8, IL-6 and TNF-α. Thirty patients were evaluated as follow: baseline, 24h-after elastomeric separator (24h-aES), 24h and 1 month after bonding the fixed appliance (aBFA) at maxillary and mandibular arch. The outcome variables were: self-reported pain, QSTs (current perception threshold, cold detection threshold, warm detection threshold, mechanical detection threshold, mechanical supra threshold and wind-up ratio, CPM and sample from the GCF in order to assess cytokines profile (IL-1ß, IL-8, IL-6 and TNF-α). ANOVA and Tukey's post hoc analyses were performed (a = 5%). The participants were divided in two groups: G1) RESPONDERS (more than 10% decrease in WUR); G2) NON-RESPONDERS (not show more than 10% decrease in WUR). T-test for independent sample was performed. A Bonferroni correction lowered the significance level to 0.1% (p = 0.001) as the cut-off point to establish the statistical significance for the mean difference between CPM responders and non-responders. Patients were less sensitive to pin prick pain (MST) at 24h (p<0.020) and 1month-aBFA (p<0.002) when compared to baseline. Significant increases in IL-6 levels were observed 24h-aBFA (p<0.023) and in IL-1ß (p<0.001) and TNF-α (p<0.026) levels at 1 month-aBFA when compared to baseline values (p<0.023). There was no significant difference in somatosensory function, pain report and GCF cytokines when compared between G1 and G2. In conclusion, orthodontic-induced inflammation may have a modality specific effect on somatosensory function of the trigeminal system. In addition, elastic separators seem not an ideal model to study possible inflammatory changes following orthodontic tooth movement. Moreover, CPM efficiency may not significantly influence somatosensory function, pain intensity or released of inflammatory cytokines following orthodontic tooth movement up to 1 month. However, remained to be confirmed and further investigations are required in intraoral somatosensory assessment.(AU)

O movimento dentário experimental demonstrou induzir inflamação e liberação de mediadores químicos. A inflamação também pode alterar a função nervosa que pode ser medida através de testes quantitativos sensoriais (QST). Vários autores estudaram a dor ortodôntica e os diferentes fatores que a modificam. Mas, ao nosso conhecimento, não há estudos avaliando o efeito da analgesia endógena individual na dor induzida por ortodontia. O objetivo do presente estudo foi investigar o impacto do separador ortodôntico e do aparelho ortodôntico fixo de curta duração na função somatossensorial e nos níveis do fluido cervical gengival (GCF) de IL-1ß, IL-8, IL-6 e TNF-α. Trinta pacientes foram avaliados da seguinte forma: valores basais, 24 horas após separador elástico (24h- AES), 24h e 1 mês após a ligação do aparelho fixo (aBFA) no arco maxilar e mandibular. As variáveis avaliadas foram: dor, QSTs (limiar de percepção elétrica, limiar de detecção ao frio, limiar de detecção ao quente, limiar de detecção mecânica, supralimiar mecânico e razão de somação temporal, CPM e amostra do GCF para avaliar perfil das citocinas ( IL-1ß, IL-8, IL-6 e TNF-α). A ANOVA e as análises post hoc de Tukey foram realizadas (a = 5%). Os participantes foram divididos em dois grupos: G1) CPM-RESPONDENTES (diminuição de mais de 10% em WUR); G2) CPM-NÃO RESPONDENTES (não mostra mais de 10% de diminuição na WUR). Foi realizado teste T para amostra independente. Uma correção de Bonferroni reduziu o nível de significância para 0,1% (p = 0,001) como ponto de corte para estabelecer a significância estatística para a diferença média entre G1 o G2. Os pacientes eram menos sensíveis à dor de pin (MST) às 24h (p <0,020) e 1 mês-aBFA (p <0,002) quando comparado à linha de base. Observaram-se aumentos significativos nos níveis de IL-6 níveis 24h-aBFA (p <0,023) e nos níveis de IL-1ß (p <0,001) e TNF-α (p <0,026) em 1 mês-aBFA quando comparados aos valores basais (p < 0,023). Não houve diferença significativa na função somatossensorial, no relatório da dor e citocinas do FCG quando comparadas entre G1 e G2. Em conclusão, a inflamação induzida por ortodontia pode ter um efeito de modalidade específico na função somatossensorial do sistema trigeminal. Além disso, os separadores elásticos não parecem ser um modelo ideal para estudar possíveis alterações inflamatórias após o movimento dentário ortodôntico. Além disso, a eficiência de CPM pode não influenciar significativamente a função somatossensorial, intensidade da dor ou liberação de citocinas inflamatórias após o movimento dentário ortodôntico até 1 mês. No entanto, outras investigações são necessárias na avaliação somatossensorial intraoral.(AU)

Notalgia Paresthetica of the Back Successfully Controlled by Pregabalin / 대한피부과학회지

Notalgia paresthetica (NP) is a chronic localized itch, affecting mainly the inter-scapular area particularly between the T2-T6 dermatomes. Occasionally it has a more widespread distribution and involves the shoulders, back, and upper chest. There are no specific cutaneous signs, apart from those attributed to scratching and rubbing. Various etiologies have been reported, but the cause of NP is not established. The current hypothesis regarding its etiology postulates that a neuropathic itch develops due to nerve entrapment of the posterior rami of spinal nerve arising at T2-T6. Another recent documented case showed an increase in the number of intradermal nerves by neural immunochistochemistry staining of S-100 protein, protein gene product 9.5 (PGP 9.5). Herein, we experienced an uncommon case of NP of the back and tried to clarify pathogenesis by using quantitative sensory testing, such as neurometer and Von-Frey filaments. Also, we performed neural immunochemistry to confirm an increase in nerve fibers at the site of the lesion.

Comparative evaluation of somatosensory mechanisms involved in orofacial somatic, visceral and neuropathic pain / Avaliação comparativa dos mecanismos somatossensoriais envolvidos na gênese das dores orofaciais de origem somática, visceral e neuropática

Orofacial pain conditions can be classified into somatic, visceral or neuropathic pain. Somatic pain is triggered by a noxious stimulus generally inducted by peripheral traumas, such as dental implants surgeries (IMP). Visceral pain initiates within internal body tissues and is normally triggered by inflammation, as in inflammatory toothaches (IT). The third condition is neuropathic pain, which results from persistent injury to the peripheral nerve as in Atypical Odontalgia (AO). The aims of this study were: 1- to investigate somatosensory abnormalities, using mechanical, painful, and electrical quantitative sensory testing (QST), in somatic (IMP patients), visceral (IT) and neuropathic pain (AO); 2- to quantify how accurately QST discriminates an IT or AO diagnosis; and 3- to investigate the influence implant surgeries or pulpectomy may have on somatosensory system and sensory nerve fibers. Sixty subjects were divided in three groups: IMP (n = 20), IT (n = 20) and AO group (n = 20). A sequence of five QSTs and the Conditioned Pain Modulation Test (CPM) were performed one month and three months after dental implant surgery (IMP group) or pulpectomy (IT group). AO group was evaluated only at baseline. QST comprehended Mechanical Detection Threshold (MDT), Mechanical Pain Threshold (MPT), Dynamical Mechanical Allodynia (DMA), Current Perception Threshold (CPT) for A-beta (frequency of 2000Hz), A-delta (250Hz) and C fibers (5Hz) and Temporal Summation Test (TS). "Z" score transformation were applied to the data, and within and between groups were statistically analyzed using two-way ANOVA. In addition, the receiver operating characteristic curve analysis, diagnostic accuracy, sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of QSTs were calculated (α = 5%). The findings of this study proved that: 1- loss of function for touch threshold and electrical threshold of C fibers is present in inflammatory toothache; 2- allodynia, hyperalgesia, gain of function for touch and pain thresholds and impaired pain modulation is detected in atypical odontalgia; 3- some QSTs may be used as complementary tests in the differential diagnosis of atypical odontalgia and inflammatory toothache with strong accuracy; 4- the most accurate QSTs for differential diagnosis between subjects with AO and IT were MDT, MPT and DMA where touch threshold forces > 1 g/mm2 and pain threshold forces > 10g/mm2 can be used to accurately discriminate AO from IT; and 5- no somatosensory modification is found after implant surgery and reduced electrical threshold in C fiber is found for patients with inflammatory toothache after 3 months of pulpectomy.(AU)

As dores orofaciais podem ser classificadas em dores somáticas, viscerais ou neuropáticas. A dor somática está relacionada a um estímulo nocivo evidente, geralmente associada a um trauma periférico, como por exemplo, nas cirurgias de implantes (IMP). As dores viscerais têm origem dentro dos órgãos e cavidades internas do corpo e são ativadas pela inflamação, como no exemplo da dor de dente do tipo Pulpite Aguda (PA). A terceira condição é a dor neuropática, que resulta de uma lesão persistente ao nervo periférico, como ocorre na Odontalgia Atípica (OA). Os objetivos deste estudo foram: 1- avaliar as alterações somatossensoriais, por meio do uso de Testes Sensoriais Quantitativos (TSQ) mecânicos, dolorosos e elétricos em dores somáticas (pacientes IMP), viscerais (PA) e neuropáticas (OA); 2- quantificar a acurácia dos TSQs na descriminação diagnóstica de uma PA ou OA; e 3- investigar alterações somatossensoriais e nas fibras nervosas sensoriais após cirurgia de instalação de implantes dentários ou pulpectomia. Sessenta sujeitos foram divididos em três grupos: IMP (n = 20), PA (n = 20) e OA (n = 20). Uma sequência de cinco TSQs e o teste de Controle da Modulação da Dor (CMD) foram realizados um mês e três meses após cirurgia de implantes (grupo IMP) ou pulpectomia (grupo PA). No grupo OA, os testes foram realizados somente uma vez no início do estudo. Os TSQs englobaram o Limiar de Detecção Mecânica (LDM), Limiar de Dor Mecânica (LDoM), Alodinia Mecânica Dinâmica (AMD), Limiar de Percepção de Corrente (LPC) para fibras A-beta (frequência de 2000Hz), A-delta (250Hz) e C (5 Hz), e o teste de Somação Temporal (ST). A transformação em escores de "Z" foi aplicada aos dados, e diferenças intra e inter-grupos foram analisadas usando ANOVA de medidas repetidas. Ainda, a acurácia diagnóstica dos TSQs foi medida por meio da sensibilidade, especificidade, razão de verossimilhança e razão de chances para diagnóstico (α = 5%). Os resultados deste estudo mostraram que: 1- perda da função em limiar táctil e limiar elétrico de fibras C está presente na Pulpite Aguda; 2- alodinia, hiperalgesia, ganho de função nos limiares de tato e de dor, e modulação da dor prejudicada são encontrados em pacientes com odontalgia atípica; 3- alguns TSQs podem ser usados como testes diagnósticos complementares ao diagnóstico diferencial entre PA e OA; 4- os TSQs com maior acurácia para o diagnóstico diferencial entre indivíduos com PA e OA foram LDM LDoM e AMD, onde uma força maior que 1 g/mm2 para limiar de tato e maior que 10 g/mm2 para limiar de dor podem ser usados com precisão; e 5- nenhuma alteração somatossensorial é encontrada após cirurgia de implantes e uma redução no limiar elétrico em fibras C é encontrado em pacientes com PA após 3 meses da pulpectomia.(AU)

Data of the quantitative orofacial somatosensory functions of healthy subjects and its influence factors analysis / 北京大学学报(医学版)

Objective:To establish the preliminary somatosensory data stratified by gender, age group, and sites in the trigeminal region through standardized quantitative sensory testing on healthy individuals, and to evaluate the effects of gender, age, and sites on somatosensory functions. Methods: The stan-dardised QST battery developed by the German Research Network on Neuropathic Pain consists totally of 13 different parameters. A total of 70 healthy individuals participated. The subjects were stratified into two groups according to age: younger group ( 16 female, 16 male, age 24 -40 years old ) and elder group (20 female, 18 male, age 41-69 years old) . The test was performed bilaterally over the infraor-bital, mental, and hand regions. Results:The preliminary orofacial somatosensory data stratified by gen-der, age group, and sites were presented. Female were more sensitive than male for most of the parame-ters ( P<0 . 05 ) . Age had a significant effect on most of the parameters ( P<0 . 05 ) , the younger group was more sensitive compared with the elder group (P<0. 01) for heat pain threshold (HPT): younger group (38. 07 ± 2. 94) ℃, elder group (39. 85 ± 3. 52) ℃;warmth detection threshold (WDT):youn-ger group (1.40 ±0.74) ℃, elder group (1.89 ±1.14) ℃; mechanical detection threshold (MDT):younger group (0. 73 ± 1. 66) mN, elder group (1. 41 ± 2. 82) mN; pressure pain threshold ( PPT):younger group ( 171. 71 ± 92. 51 ) kPa, elder group ( 196. 36 ± 73. 73 ) kPa; cold pain threshold (CPT):younger group (25. 90 ± 5. 38) ℃, elder group (21. 64 ± 6. 78) ℃; cold detection threshold (CDT):younger group ( -0. 97 ± 0. 55) ℃, elder group ( -1. 36 ± 0. 90) ℃, and wind-up ratio (WUR):younger group (3. 33 ± 2. 20), elder group (2. 67 ± 1. 68). The inverse results were demon-strated for mechanical pain threshold ( MPT ): younger group ( 111. 50 ± 88. 93 ) mN, elder group (104. 49 ± 94. 94) mN;mechanical pain sensitivity (MPS):younger group (6. 96 ± 5. 61), elder group (8.93 ±6.53), and vibration detection threshold (VDT): younger group (7.44 ±0.52) scale, elder group (7.55 ±0.48) scale (P<0.05). Somatosensory function was site dependent (P<0.001), the two trigeminal sites ( infraorbital and mental) were more sensitive than the hand for CDT, HPT, WDT, thermal sensory limen (TSL), MDT, MPT, MPS, and PPT (P <0. 001), but the inverse result was observed for VDT ( P <0 . 001 ) . Conclusion: The preliminary orofacial somatosensory data of Han Ethnicity stratified by gender, age group, and sites were established. The study evaluated the effects of gender , age and sites on orofacial somatosensory functions by employment standardized quantitative senso-ry testing.

The quantitative sensory testing is an efficient objective method for assessment of nerve injury / 대한악안면성형재건외과학회지

BACKGROUND: This study evaluated Somatosensory evoked potentials (SEP), Quantitative sensory testing (QST), and thermography as diagnostic methods for nerve injury. METHODS: From 2006 through 2011, 17 patients (mean age: 50.1 years) from OOOO Hospital who sought care for altered sensation after dental implant treatment were identified. The mean time of objective assessment was 15.2 months after onset. RESULTS: SEP of Inferior alveolar nerve(IAN) was 15.87 +/- 0.87 ms on the normal side and 16.18 +/- 0.73 ms on the abnormal side. There was delayed N20 latency on the abnormal side, but the difference was not statistically significant. In QST, the abnormal side showed significantly higher scores of the current perception threshold at 2 KHz, 250 Hz, and 5 Hz. The absolute temperature difference was 0.55degrees C without statistically significance. CONCLUSION: These results indicate that QST is valuable as an objective method for assessment of nerve injury.

The role of xerostomia in burning mouth syndrome: a case-control study / O papel da xerostomia na sindrome da ardencia bucal: estudo caso controle

Objective : To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). Method : Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic – Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. Results : There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). Conclusion : In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation. .

Objetivo : Avaliar a eficácia do uso de medicação tópica anti xerostomica (ureia 10%) em pacientes com síndrome de ardência bucal. Método : Trinta e oito sujeitos diagnosticados com síndrome de ardência bucal de acordo com os critérios da Associação Internacional para Estudo da Dor foram randomizados para grupo placebo (5% de carboximetilcelulose de sódio, 0,15% de metilparabeno e 10% de glicerol em água destilada qsp 100g) ou grupo tratamento (ureia 10%) para ser aplicada na cavidade oral 3-4 vezes ao dia, durante três meses. Os pacientes foram avaliados antes e depois do tratamento: protocolo EDOF-HC, questionário de xerostomia, testes sensitivos quantitativos. Resultados : Não houve diferenças no fluxo salivar, limiares gustativos, olfativos e somestésicos (Mann-Whitney P>0,05). Quinze (60%) dos pacientes tiveram melhora com o tratamento (P=0,336, oneway ANOVA ). Conclusão : Em conclusão não houve diferenças entre os grupos, ambos apresentaram uma associação entre melhora e salivação. .

Application of quantitative sensory testing in diagnosis of hemodialysis patients with peripheral neuropathy / 中华行为医学与脑科学杂志

ObjectiveTo evaluate the application of quantitative sensory testing(QST) in hemodialysis (HD) patients with peripheral neuropathy.MethodsThe values of the quantitative sensory testing and sensory conduction velocity at different locations of extremities in 40 cases of the HD patients and 40 normal persons were recorded.ResultsAccording to the control group,without symptoms group and with symptoms group,the thermal threshold(TT) and vibratory threshold (VT) at the four different locations of extremities were increased,thresholds of the later two groups were significantly higher than those of normal controls (P ＜ 0.05 ).Especially finger warm and vibratory thresholds,hypothenar heat pain thresholds,instep heat pain and vibratory thresholds,calf cold pain and vibratory thresholds were significantly difference between with symptoms group and normal control group (P＜0.01 ).Finger cool and warm thresholds,instep heat pain thresholds,thresholds of calf warm,cold pain and heat pain,and vibratory thresholds at the four different locations of extremities were significantly difference between wthout symptoms group and with symptoms group (P＜ 0.05).The SCV values of the median nerve,tibial nerve and lateral popliteal nerve were significantly difference between HD patients group and normal control(P ＜0.05 ).The total abnormal rate of QST was 65％,with symptoms group was 77.27％,total abnormal rate of SCV was 55.0％,with symptoms group was 68.18％.The total abnormal rate of QST were significantly higher than those of SCV (P＜0.01 ).ConclusionQST is a sensitive method for diagnosis of uremic neuropathy.

The Effect of Leflunomide on Cold and Vibratory Sensation in Patients with Rheumatoid Arthritis

OBJECTIVE: To evaluate the prevalence and risk factors of peripheral neuropathy in patients with rheumatoid arthritis (RA) treated with leflunomide (LEF) by quantitative sensory testing (QST). METHOD: A total of 94 patients were enrolledin this study, out of which 47 patients received LEF. The other 47 patients received alternative disease-modifying antirheumatic drugs and served as the control group. The demographic characteristics, laboratory findings, concomitant diseases, and medication history were evaluated at the time of QST. The cooling (CDT) and vibratory detection threshold (VDT) as the representative components of QST were measured. RESULTS: Age, gender, RA duration, ESR, and CRP did not show any significant differences between the two groups. VDT did not demonstrate any significant difference in both groups. However, CDT in LEF group was significantly higher than that of the control group (8.6+/-2.7 in LEF vs. 5.6+/-3.8 in control). The proportion of RA patients in the LEF group showing abnormally high CDT was over 2 times greater than that of the control group, but these findings were not statistically significant. Age, RA duration (or LEF medication in LEF group), ESR, and CRP did not show significant correlation with CDT in both groups. VDT significantly correlated with age in both groups. CONCLUSION: LEF treatment in patients with RA may lead to abnormal CDT in QST. CDT value was not affected by age, RA duration, disease activity, or LEF duration. It remains to be determined whether QST may be a valuable non-invasive instrument to evaluate the early sensory changes in patients with RA taking LEF.

Validation of a Brazilian quantitative sensory testing (QST) device for the diagnosis of small fiber neuropathies / Validação de um aparelho brasileiro de teste de quantificação sensitiva brasileiro para o diagnóstico de neuropatia de fibras finas

Quantitative sensory testing (QST) is defined as the determination of thresholds for sensory perception under controlled stimulus. Our aim was to validate a new QST device for Brazilian sample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm² thermode with a 1°C/s stimulus change rate were applied. Thresholds of three consecutive stimuli were averaged in two different sessions separated by at least two weeks. Additionally long thermal heat pain stimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermal perception thresholds in normal individuals and plausible abnormal thresholds in patients. We conclude that our QST device is reliable when analyzing the nociceptive pathway in controls and patients.

Teste de quantificação sensitiva (TQS) significa determinação de limiares de percepção sensitiva frente a um estímulo de intensidade controlada. Nosso objetivo foi validar um novo equipamento de TQS adaptado à população brasileira. Em 20 adultos saudáveis, limiares termoalgésicos foram avaliados, utilizando um aparelho protótipo do TQS (Heat Pain Stimulator-1.1.10; Brazil). Foi utilizado um termodo de 30 × 30 mm², com estímulo térmico de 1°C/s. A média dos limiares de três estímulos consecutivos foi obtida em duas sessões diferentes, separadas por pelo menos 2 semanas. Adicionalmente, foram aplicados estímulos térmicos dolorosos de longa duração. Para avaliar a consistência do nosso método, foram também analisados 11 pacientes com neuropatia de fibras finas. Os resultados mostraram boa reprodutibilidade dos limiares de percepção nos indivíduos saudáveis, assim como limiares anormais nos pacientes. Em conclusão, nosso aparelho de TQS apresentou boa confiabilidade ao analisar a via nociceptiva de controles e pacientes.

The sensitivity and specificity of quantitative sensory testing in screening diabetic peripheral neuropathy of the early stage / 中国医师进修杂志

Objective To evaluate the clinical significance of quantitative sensory testing (QST) in screening diabetic peripheral neuropathy of the early stage. Methods One hundred patients with type 2 diabetes mellitus were examined by nerve conduction velocity (NCV) and QST examination. With the NCV positive as the gold criterion for screening diabetic peripheral neuropathy of the early stage, the sensitivity and specificity of QST was further analyzed for diagnosis of the early stage diabetic peripheral neuropathy. Results Among the 100 patients with type 2 diabetes mellitus,there were 41 cases positive and 59 cases negative in NCV examination. On the other hand,there were 74 cases positive,and 26 cases negative in QST. The sensitivity and specificity of QST for the diagnosis of early stage diabetic peripheral neuropathy was 97.56% (40/41) and 42.37% (25/59). Conclusions In the screening of early stage diabetic peripheral neuropathy,QST shows higher detection sensitivity,but lower specificity than NCV examination. Therefore, QST may be an examination for the supplement of the routine electromyography.

Gender Differences in Heat Pain and Temporal Summation Threshold in Normal Volunteers / 대한통증학회지

BACKGROUND: Females generally have a lower pain and temporal summation threshold than men. However, the results of studies designed to evaluate gender differences in the thresholds of heat pain and the temporal summation have been inconsistent. Newly developed device, CHEPS (Contact Heat Evoked Potential Stimulation) model of PATHWAY, have superiority on its fast rise and return time in temperature. Therefore we investigated gender differences in heat pain and temporal summation threshold. METHODS: Forty healthy volunteers (20 males and 20 females) were enrolled in this study. A thermode was applied to the volar side of each volunteer's left forearm and heat pain and the temporal summation threshold was then measured. The heat pain threshold was estimated using the staircase method by starting from 36degrees C and then increasing the temperature in 0.5degrees C increments. The temporal summation threshold was estimated by applying five successive stimulation of the same temperature starting at 2degrees C lower than the heat pain threshold and then increasing the temperature in 0.5degrees C increments. RESULTS: The mean heat pain thresholds was found to be 41.63 +/- 1.63degrees C for males and 41.60 +/- 1.84degrees C for females and the temporal summation thresholds were found to be 40.83 +/- 1.64degrees C for males and 40.77 +/- 1.93degrees C for females. The differences between males and females were not statistically significant. CONCLUSIONS: The result of this study suggested that there are no gender differences in heat pain and temporal summation threshold.

Temperature Sensation Threshold at Different Skin Sites of the Upper Limbs:20 Normal Subjects Reports / 中国康复理论与实践

@#Objective To observe the thermal thresholds in normal subjects and their relation with gender and site.MethodsThe thresholds of sensation of cold,warm,cold pain and hot pain in 20 healthy subjects were measured at 10 sites of upper limbs with the TSA-Ⅱ Neurosensory Analyzer under the Limits model.ResultsThere was no remarkable differences between the thresholds of sensation of cold and warm,but obvious differences between the sensation of cold pain and hot pain in different skin sites,as well as between the males and females,left and right in some sensation and some sites.ConclusionFor the normal people,there is a certain relationship among thermal threshold and gender or site of body.

The thermal and vibratory thresholds in normal subjects / 重庆医科大学学报

Objective:To know the thermal and vibratory thresholds in normal subjects and their relation with age,sex,site and methods.Methods:We used TSA-2001 Ther mal Sensory Analyzer and VSA-6003 Vibratory Sensory Analyzer.Thermal and vibratory tests were performed in 100 healthy subjects on four sites with two methods(reaction time inclusive method and reaction time exclusive method).Results:The normative data of thermal and vibratory thresholds were presented in the table 2 to table 4 in the paper.There were no significant differences in TT and VT between men and females.TT and VT increased with age.There was difference in different sites.TT and VT obtained by the method of limits were higher than those obtained by the method of levels or staircases and it showed a significant positive correlation with each other.Repeatability of the QST allowed for longitudinal studies.Conclusion:QST may assess the sensory functions of human body quantitatively,and the TT and VT are influenced by testing method,site and age of subjects.

Investigation on the degree of sensory disturbance in patients with cerebral infarction,diabetes mellitus and cerebral infarction combined diabetes mellitus / 临床神经病学杂志

Objective To research the degree of sensory disturbance(about algaesthesis and thermesthesia) in patients with cerebral infarction(CI),diabetes mellitus(DM) and CI combined DM(CD).Methods The threshold values of rhigosis,heat sensation,cryalgesia and thermalgesia were detected by quantitative sensory testing(QST) in the patients with CI(CI group),DM(DM group),CD(CD group).Each group had 30 cases.The results were compared with normal control group(NC group).Results Compared with NC group,acral thermic sense and cryalgesia in CI group and CD group were declined obviously(all P

Early diagnostic value of quantitative sensory testing in diabetes with peripheral neuropathy / 临床神经病学杂志

Objective To explore the early diagnostic value of quantitative sensory testing (QST) in diabetes with peripheral neuropathy (PNP).Methods The nerve conduction velocity (NCV) and QST were examined in 46 diabetic patients, and their results were compared. Results The abnormal ratio of NCV in 46 patients was 72.8%. 32 cases (69.6%) were diagnosed as diabetes with PNP. While using QST, the abnormal ratio was 91.3%. 40 cases (86.9%) were diagnosed as diabetes with PNP. There was a significant difference between two methods ( P