QST Screening & Bedside Exams for Patients with Chronic Pain

Research explores the added value of screening QST and bedside examination to advance the identification of neuropathic pain in patients suffering from chronic pain.


New research published in the July 10, 2018 edition of the Journal of Pain Research, has been conducted by a team of professors from the Netherlands on a neuropathic pain component (NePC). The Assessment of the severity and presence of a NePC is key in making a diagnosis in patients suffering from chronic (more than 3 months) pain patients. Currently, the valuation of a NePC to ascertain the neurological benchmarks needed to adhere to the clinical description, is based on quantitative sensory testing (QST), history taking, and clinical examination, and comprises bedside examination (BSE).

The single-blind study aimed to ascertain the probability of a link between the clinical diagnoses of an absence or presence of an NePC, bedside examination (BSE), as well as the NASQ (Nijmegen–Aalborg screening) paradigm (electrical pain thresholds, conditioned pain modulation, and pressure algometry) in patients suffering from chronic pain in the neck, shoulder or arm; from suspected peripheral damage to the nerves; or pain in the lower back (LBP) and leg.


The study comprised 291 patients in total. Pain (the presence or absence of neuropathic pain) was evaluated individually by two physicians and then compared with BSE — the measurement of touch [brush, finger], cold, heat, vibration, or pricking [von Frey hair, safety pin]. The NASQ paradigm (see above) was weighed up in 58 patients to produce fresh insights.


The bedside examination showed only a minimal association of variances between patients with either present or absent NePC. In fact, pricking sensations with a von Frey hair, as well as the use of heat and cold, were statistically much less typical among those patients with existing NePC. Bottom line, the NASQ did not uncover any dissimilarities between those without or those with an NePC.


At present, a uniform BSE seems to be more valuable than the NASQ paradigm when differentiating between patients without and with a NePC.


The authors of the study were Oliver HG Wilder-Smith, Kris CP Vissers, Monique AH Steegers, Hans Timmerman, and André P Wolff. The research involved the participation of the following universities: Radboud University Medical Center’s Anesthesiology, Pain and Palliative Medicine department (in Nijmegen); the Sensory-Motor Interaction Center at the Alborg University (Aalborg, Denmark); as well as the Department of Anesthesiology, Pain Center, University of Groningen, University Medical Center Groningen (Netherlands).