Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aarhus N, Denmark.
Reg Anesth Pain Med. 2012 Sep-Oct;37(5):530-6. doi: 10.1097/AAP.0b013e3182632c40.
Quantitative sensory testing (QST) has proven to be an important instrument to characterize mechanisms underlying somatic and neuropathic pain disorders. However, its reliability has not previously been established in patients with visceral pain. We investigated the test-retest reliability of static and dynamic QST in patients with visceral pain due to chronic pancreatitis.
Sixty-two patients (38 men, 53 [11] y) with painful chronic pancreatitis were included. Static QST comprised sensory thresholds for pressure and electrical stimulation performed in the ventral and dorsal T10 dermatomes (sharing spinal innervation with the pancreas, ie, pancreatic viscerotomes) and in 4 heterologous regions (control areas). Dynamic QST comprised conditioned pain modulation. Measurements were obtained from 2 subsequent test sessions separated by 1 week.
The reliability of static QST was generally high, with the best test-retest performance seen for pressure pain thresholds (intraclass correlation coefficients [ICC], 0.74) and electrical sensation thresholds (ICC, 0.66). In contrast, the reliability of dynamic QST was poor (ICC, 0.01). For static QST measures, the reliability was higher for pain thresholds compared with suprapain thresholds (P < 0.01). No differences between assessments in the pancreatic viscerotomes compared with heterologous regions were seen (P = 0.6).
Sensory thresholds in the pancreatic viscerotomes and control areas were reproducible over time. In contrast, dynamic QST measurements reflecting active central modulation of pain processing state (ie, conditioned pain modulation) were not stable over time and showed considerable variability. These factors should be taken into consideration in case QST is used to follow disease mechanisms, drug effects, or effects of pain intervention.
定量感觉测试（QST）已被证明是一种重要的工具，可用于描述躯体和神经性疼痛障碍的潜在机制。然而，其在内脏疼痛患者中的可靠性尚未得到证实。我们研究了慢性胰腺炎引起的内脏疼痛患者的静态和动态 QST 的测试-重测信度。
纳入 62 例（38 名男性，53[11]岁）有疼痛的慢性胰腺炎患者。静态 QST 包括在 T10 腹侧和背侧皮节（与胰腺共享脊髓神经支配，即胰腺内脏皮节）以及 4 个异质区域（对照区）进行的压力和电刺激感觉阈值。动态 QST 包括条件性疼痛调制。在 1 周的间隔内进行 2 次后续测试。
静态 QST 的可靠性通常较高，压力疼痛阈值的测试-重测性能最佳（组内相关系数 [ICC]，0.74）和电感觉阈值（ICC，0.66）。相比之下，动态 QST 的可靠性较差（ICC，0.01）。对于静态 QST 测量，与超痛阈值相比，疼痛阈值的可靠性更高（P <0.01）。在胰腺内脏皮节与异质区域的评估之间未观察到差异（P = 0.6）。
胰腺内脏皮节和对照区的感觉阈值随时间推移具有可重复性。相比之下，反映疼痛处理状态主动中枢调制的动态 QST 测量值在时间上不稳定，并且表现出相当大的变异性。在使用 QST 来跟踪疾病机制、药物效应或疼痛干预效果的情况下，应考虑这些因素。
