Abstract
Background:Quantitative Sensory Testing (QST) has been used in clinical and experimental settings to establish sensory assessment for different types of pains, and may be a useful tool for the assessment of orofacial pain, but this premise needs to be tested.Objective:The aim of the study was to evaluate responses to thermal stimuli between painful and non-painful facial sites in subjects with orofacial pain using QST.Methods:A total of 60 participants (5o females: 28-83 years; 10 males: 44-81 years) with unilateral orofacial pain were recruited from the Orofacial Pain Clinic at the Pain Management and Research Centre, Royal North Shore Hospital, Sydney, Australia. The study followed the methods of limits of the German Research Network testing four modalities of thermal thresholds, the Warm Sensation, the Cold Sensation, the Heat Pain and the Cold Pain using a TSA-II Neurosensory Analyser. The results were compared to the results from the unaffected side of the same patient on the same area and a single t test statistical analysis was performed, where a p value of less than 0.05 was considered significant.Results:The Mean Difference for Cold Sensation between the pain side and the non-pain side was 0.48 °C ± 1.5 (t= 2.466, p=0.017), 0.68 °C ± 2.04 for Warm Sensation (t= -2.573, p= 0.013), 2.56 °C ± 2.74 for Cold Pain (t= 7.238, p<0.001) and -1.21 °C ± 2.59 for Hot Pain (t= -3.639, p=0.001).Conclusion:The study showed that QST methods using thermal stimuli could be used to evaluate sensory dysfunction in orofacial pain patients using the specific parameters of cool and warm sensation, and cold and hot pain.
Highlights
Pain assessment in the context of a reaction to an impulse of temperature using a computerised thermoset, such as Quantitative Sensory Testing (QST) has been used effectively over the past two decades as a reliable method for detecting and quantifying positive and negative sensory phenomena in different types of neuropathies and chronic pain conditions
The project was approved by the Human Research Ethics Committee (HREC) of Northern Sydney Central Coast Area Health (NSCCH) and the Human Research Ethics Committee of The University of Sydney
In the Langemark study [13], there were significant differences in thermal thresholds between pain patients and volunteers when comparing sites that did not have any relation with headache, such as palms of the hands. These results suggest that patients with different types of orofacial pain conditions exhibit different models of thermal dysfunction when tested with QST methods
Summary
Pain assessment in the context of a reaction to an impulse of temperature using a computerised thermoset, such as Quantitative Sensory Testing (QST) has been used effectively over the past two decades as a reliable method for detecting and quantifying positive and negative sensory phenomena in different types of neuropathies and chronic pain conditions. QST has been used to examine deep pain and cutaneous sensitivity to generate sensory sign profiles for thermal and mechanical stimuli [3 - 7]. The German Research Network on neuropathic Pain (DFNS) has developed a standardized QST protocol in which cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT) and heat pain threshold (HPT) can be measured following the method of limits [5]. Quantitative Sensory Testing (QST) has been used in clinical and experimental settings to establish sensory assessment for different types of pains, and may be a useful tool for the assessment of orofacial pain, but this premise needs to be tested
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