title: Overcoming pain thresholds with multilevel models-an example using quantitative sensory testing (QST) data.
abstract: The assessment of somatosensory function is a cornerstone of research and clinical practice in neurology. Recent initiatives have developed novel protocols for quantitative sensory testing (QST). Application of these methods led to intriguing findings, such as the presence lower pain-thresholds in healthy children compared to healthy adolescents. In this article, we (re-) introduce the basic concepts of signal detection theory (SDT) as a method to investigate such differences in somatosensory function in detail. SDT describes participants' responses according to two parameters, sensitivity and response-bias. Sensitivity refers to individuals' ability to discriminate between painful and non-painful stimulations. Response-bias refers to individuals' criterion for giving a "painful" response. We describe how multilevel models can be used to estimate these parameters and to overcome central critiques of these methods. To provide an example we apply these methods to data from the mechanical pain sensitivity test of the QST protocol. The results show that adolescents are more sensitive to mechanical pain and contradict the idea that younger children simply use more lenient criteria to report pain. Overall, we hope that the wider use of multilevel modeling to describe somatosensory functioning may advance neurology research and practice.
authors.affiliation: Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück , Osnabrück , Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Hirschfeld
authors.affiliation: Chair for Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University , Witten/Herdecke , Germany ; Department for Pediatric Neurology, Psychosomatic and Pain Medicine, Center for Child and Adolescent Medicine Olgahospital, Klinikum Stuttgart , Stuttgart , Germany.
authors.forename: Markus R
authors.initials: MR
authors.lastname: Blankenburg
authors.affiliation: Department for Psychology, University Düsseldorf , Düsseldorf , Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Süß
authors.affiliation: Chair for Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University , Witten/Herdecke , Germany ; German Pediatric Pain Centre-Children's Hospital Datteln, Witten/Herdecke University , Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Zernikow
keywords: Multilevel models; Pain; Quantitative sensory testing; Sensitivity; Signal detection theory; Thresholds