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Pain. 2016 Mar;157(3):750-8. doi: 10.1097/j.pain.0000000000000433.

Quantitative sensory testing using DFNS protocol in Europe: an evaluation of heterogeneity across multiple centers in patients with peripheral neuropathic pain and healthy subjects.

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aDepartment of Pain Medicine, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Bochum, Germany bCenter of Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany cINSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France dUniversité Versailles-Saint-Quentin, Versailles, France eDivision of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany fDepartment of Anaesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Tutzing, Tutzing, Germany gDepartment of Anaethesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany hHelsinki University Central Hospital, Helsinki, Finland iEtera Mutual Pension Insurance Company, Helsinki, Finland jDepartment of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway kDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden lDepartment of Neurology, Danish Pain Research Center, Aarhus University Hospital, Denmark mPain Research, Department of Surgery and Cancer, Imperial College, London, United Kingdom nH. Lundbeck A/S, Copenhagen, Denmark oDepartment of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden pNeuroscience Technologies, Ltd, Barcelona, Spain qDepartment of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark rDepartment of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.


Quantitative sensory testing (QST) in accordance with the DFNS (German Research Network on Neuropathic Pain) protocol assesses the function of afferent nerve fibers on the basis of 13 parameters. Within the consortia IMI (Innovative Medicines Initiative) Europain and Neuropain, QST results from pain research units experienced in QST across Europe can be compared for the first time. Aim of this analysis was to identify possible biases in the QST assessment between 10 centers from 8 different European countries. In total, 188 healthy subjects, 217 patients with painful polyneuropathy, and 150 patients with painful peripheral nerve injury were included in the analysis. Mixed effects models were constructed for each of the 11 normally distributed QST parameters with z-value as the dependent variable, and center as the random effect. The I statistic for heterogeneity was calculated, an index ranging from 0% (no heterogeneity) to 100% (perfect heterogeneity). Data from healthy subjects were comparable with the existing reference data base. Patients with polyneuropathy mainly displayed loss of sensory function, whereas patients with peripheral nerve injury often showed sensory loss combined with mechanical hyperalgesia. Heterogeneity was overall low between different centers and parameters. There was no systematic heterogeneity for patients with painful peripheral nerve injury and painful polyneuropathy. For healthy subjects, only blunt pressure pain threshold showed a considerable heterogeneity of 42% (95% confidence interval: 0%-66%). In conclusion, QST of both healthy subjects and patients with peripheral neuropathic pain is largely homogenous within the European centers, an essential prerequisite for performing multicenter QST-based studies.

[Indexed for MEDLINE]

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