德国神经性疼痛研究网络（DFNS）中的定量感觉测试：标准化方案及参考值

Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values.

作者信息

Rolke R, Baron R, Maier C, Tölle T R, Treede - D R, Beyer A, Binder A, Birbaumer N, Birklein F, Bötefür I C, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer G B, Magerl W, Maihöfner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B

机构信息

Institute of Physiology and Pathophysiology, Johannes Gutenberg-University, Mainz, Germany Department of Neurology, Johannes Gutenberg-University, Mainz, Germany Division of Neurological Pain Research and Therapy, Department of Neurology, University of Kiel, Germany Department of Pain Management, BG Kliniken Bergmannsheil, Ruhr University Bochum, Germany Department of Neurology, Technische Universität München, Germany Department of Anaesthesiology, Ludwig-Maximilians-Universität München, Germany Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Germany Department of Neurology, University of Freiburg, Germany Institute of Clinical and Cognitive Neuroscience, University of Mannheim, Germany Department of Neurology, University of Ulm, Germany Institute of Physiology and Experimental Pathophysiology, University of Erlangen, Germany.

出版信息

Pain. 2006 Aug;123(3):231-243. doi: 10.1016/j.pain.2006.01.041. Epub 2006 May 11.

DOI:10.1016/j.pain.2006.01.041

PMID:16697110

Abstract

The nationwide multicenter trials of the German Research Network on Neuropathic Pain (DFNS) aim to characterize the somatosensory phenotype of patients with neuropathic pain. For this purpose, we have implemented a standardized quantitative sensory testing (QST) protocol giving a complete profile for one region within 30 min. To judge plus or minus signs in patients we have now established age- and gender-matched absolute and relative QST reference values from 180 healthy subjects, assessed bilaterally over face, hand and foot. We determined thermal detection and pain thresholds including a test for paradoxical heat sensations, mechanical detection thresholds to von Frey filaments and a 64 Hz tuning fork, mechanical pain thresholds to pinprick stimuli and blunt pressure, stimulus/response-functions for pinprick and dynamic mechanical allodynia, and pain summation (wind-up ratio). QST parameters were region specific and age dependent. Pain thresholds were significantly lower in women than men. Detection thresholds were generally independent of gender. Reference data were normalized to the specific group means and variances (region, age, gender) by calculating z-scores. Due to confidence limits close to the respective limits of the possible data range, heat hypoalgesia, cold hypoalgesia, and mechanical hyperesthesia can hardly be diagnosed. Nevertheless, these parameters can be used for group comparisons. Sensitivity is enhanced by side-to-side comparisons by a factor ranging from 1.1 to 2.5. Relative comparisons across body regions do not offer advantages over absolute reference values. Application of this standardized QST protocol in patients and human surrogate models will allow to infer underlying mechanisms from somatosensory phenotypes.

摘要

德国神经性疼痛研究网络（DFNS）的全国多中心试验旨在描述神经性疼痛患者的躯体感觉表型。为此，我们实施了一项标准化的定量感觉测试（QST）方案，可在30分钟内给出一个区域的完整概况。为了判断患者的正负体征，我们现在从180名健康受试者中建立了年龄和性别匹配的绝对和相对QST参考值，对其面部、手部和足部进行双侧评估。我们测定了热觉检测和疼痛阈值，包括对冷痛觉过敏的测试、对von Frey细丝和64赫兹音叉的机械检测阈值、对针刺刺激和钝性压力的机械疼痛阈值、针刺和动态机械性异常性疼痛的刺激/反应函数以及疼痛总和（累积比率）。QST参数具有区域特异性且与年龄相关。女性的疼痛阈值显著低于男性。检测阈值通常与性别无关。通过计算z分数，将参考数据归一化为特定组的均值和方差（区域、年龄、性别）。由于置信限接近可能数据范围的各自极限，热觉减退、冷觉减退和机械性感觉过敏几乎无法诊断。然而，这些参数可用于组间比较。通过左右对比，敏感性可提高1.1至2.5倍。跨身体区域的相对比较与绝对参考值相比并无优势。在患者和人类替代模型中应用这种标准化的QST方案将有助于从躯体感觉表型推断潜在机制。