The Importance of Quantitative Sensory Testing in the Clinical Setting

Abstract

As the previous chapters in this volume attest, there is considerable evidence of abnormal pain perception across a wide range of clinical conditions. The pattern of abnormalities varies across clinical syndromes, and findings include enhanced sensitivity to painful stimuli in some populations (e.g. fibromyalgia), diminished sensitivity to painful stimuli in other conditions (e.g. hypertension), and more specific abnormalities (e.g. hyperpathia) in other disorders (e.g. central lesions). These differing patterns of results reflect differing underlying mechanisms and may provide important information regarding the pathophysiology, diagnosis and treatment of these clinical conditions. This growing body of evidence indicating alterations in pain perception in many clinical populations suggests that experimental pain assessment, or quantitative sensory testing (QST), has substantial clinical value. This chapter will provide an overview of the clinical utility of QST. First, the multiple purposes of experimental pain assessment will be reviewed, and the advantages and disadvantages of QST will be discussed. Then, findings relating to the clinical value of QST will be presented, including a discussion of testing procedures that may be particularly clinically relevant. Finally, the chapter will conclude with a discussion of the future of QST in the clinical management of patients with disorders characterized by abnormal pain perception. Throughout the chapter the term QST will be used to include a variety of psychophysical procedures, including various methods for assessing experimental pain responses. At times, the terms experimental pain sensitivity or experimental pain perception will be used as well. While distinctions among the terms can be made, for convinience the term are used relatively interchangeably in this chapter.