Methods to Measure Peripheral and Central Pain Sensitization Using QST: focus on Low Back Pain

Peripheral and Central Pain Sensitization

This paper proposes a standardized method for performing various modalities of quantitative sensory testing (QST) in patients with low back pain. It concludes that such QST protocol can help to evaluate the mechanisms of low back pain – central and peripheral – and can be used for individualized treatment, based on the mechanism involved. Quantitative sensory testing (QST) is a non-invasive method to evaluate the function of small and large nerve fibers, and of peripheral and central sensory pathways.

QST is used in many studies for various approaches, with a large variation between used protocols.

This article’s purpose is to provide a standard protocol for using QST in patients with low back pain (LBP). The QST measures described in this paper are mechanical pain threshold and pain tolerance, mechanical temporal summation, dynamic mechanical allodynia; vibration detection threshold; thermal testing; including warm and cold detection thresholds and heat and cold pain thresholds; conditioned pain modulation test (with thermal test and conditioning stimuli); thermal temporal summation; pressure pain threshold.

The paper describes the protocol for each measurement, equipment used and analysis techniques. It emphasizes the importance of the measurement standardization, raises further steps that need to be taken to implement QST into clinical practice. It furthermore suggests that QST can be used for various approaches – detecting individual pain perception differences, dividing between peripheral and central mechanisms of pain, etc..

QST can serve to develop personalized treatment based on the individual pain mechanism, and be utilized as an evaluation tool for the treatment's effectiveness. To read the full-text article:

Starkweather, A. R., Heineman, A., Storey, S., Rubia, G., Lyon, D. E., Greenspan, J., & Dorsey, S. G. (2016). Methods to measure peripheral and central sensitization using quantitative sensory testing: A focus on individuals with low back pain.Applied Nursing Research,29, 237-241.