title: Thermal thresholds in complex regional pain syndrome type I: sensitivity and repeatability of the methods of limits and levels.
abstract: OBJECTIVE
  To study whether the method of levels (MLE) or the method of limits (MLI) is preferable as a method of measuring thermal perception thresholds in patients with complex regional pain syndrome type I (CRPS I).
  
  
  METHODS
  Perception thresholds for warmth and cold were measured twice, with both MLE and MLI, at a 1 month interval, both at unaffected and affected wrists (n=33) or feet (n=20) of patients with CRPS I of one extremity.
  
  
  RESULTS
  (1) Sensitivity for pathology was equal for both methods. (2) The agreement between thresholds measured by both methods was low at all locations, except for the unaffected wrist. Since thresholds measured with the MLI always contain reaction time artefacts, this lack of agreement favours the MLE. (3) At both unaffected and affected wrists, the MLE showed significantly better coefficients of repeatability as compared to the MLI for both sensations. However, at both unaffected and affected feet, there was no preference for either method as far as threshold measurement repeatability was concerned.
  
  
  CONCLUSIONS
  Abnormal thermal perception thresholds occurred in 20% (foot) to 36% (wrist) of the CRPS I patients on the affected side and in 15% (foot, wrist) on the unaffected side. The MLE is considered to be the preferable method to assess thermal perception thresholds in CRPS I.
authors.affiliation: Department of Surgery, Maastricht University Hospital, The, Maastricht, Netherlands. mkeml@shee.azm.nl
authors.forename: M A
authors.initials: MA
authors.lastname: Kemler
authors.forename: J P
authors.initials: JP
authors.lastname: Reulen
authors.forename: M
authors.initials: M
authors.lastname: van Kleef
authors.forename: G A
authors.initials: GA
authors.lastname: Barendse
authors.forename: F A
authors.initials: FA
authors.lastname: van den Wildenberg
authors.forename: F
authors.initials: F
authors.lastname: Spaans
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold / Q000502:physiology*; D012019:Reflex Sympathetic Dystrophy / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013577:Syndrome