title: Quantitative sensory testing using DFNS protocol in Europe: an evaluation of heterogeneity across multiple centers in patients with peripheral neuropathic pain and healthy subjects.
abstract: Quantitative sensory testing (QST) in accordance with the DFNS (German Research Network on Neuropathic Pain) protocol assesses the function of afferent nerve fibers on the basis of 13 parameters. Within the consortia IMI (Innovative Medicines Initiative) Europain and Neuropain, QST results from pain research units experienced in QST across Europe can be compared for the first time. Aim of this analysis was to identify possible biases in the QST assessment between 10 centers from 8 different European countries. In total, 188 healthy subjects, 217 patients with painful polyneuropathy, and 150 patients with painful peripheral nerve injury were included in the analysis. Mixed effects models were constructed for each of the 11 normally distributed QST parameters with z-value as the dependent variable, and center as the random effect. The I statistic for heterogeneity was calculated, an index ranging from 0% (no heterogeneity) to 100% (perfect heterogeneity). Data from healthy subjects were comparable with the existing reference data base. Patients with polyneuropathy mainly displayed loss of sensory function, whereas patients with peripheral nerve injury often showed sensory loss combined with mechanical hyperalgesia. Heterogeneity was overall low between different centers and parameters. There was no systematic heterogeneity for patients with painful peripheral nerve injury and painful polyneuropathy. For healthy subjects, only blunt pressure pain threshold showed a considerable heterogeneity of 42% (95% confidence interval: 0%-66%). In conclusion, QST of both healthy subjects and patients with peripheral neuropathic pain is largely homogenous within the European centers, an essential prerequisite for performing multicenter QST-based studies.
authors.affiliation: Department of Pain Medicine, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Bochum, Germany Center of Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France Université Versailles-Saint-Quentin, Versailles, France Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany Department of Anaesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Tutzing, Tutzing, Germany Department of Anaethesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Helsinki University Central Hospital, Helsinki, Finland Etera Mutual Pension Insurance Company, Helsinki, Finland Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Department of Neurology, Danish Pain Research Center, Aarhus University Hospital, Denmark Pain Research, Department of Surgery and Cancer, Imperial College, London, United Kingdom H. Lundbeck A/S, Copenhagen, Denmark Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden Neuroscience Technologies, Ltd, Barcelona, Spain Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Vollert
authors.forename: Nadine
authors.initials: N
authors.lastname: Attal
authors.forename: Ralf
authors.initials: R
authors.lastname: Baron
authors.forename: Rainer
authors.initials: R
authors.lastname: Freynhagen
authors.forename: Maija
authors.initials: M
authors.lastname: Haanpää
authors.forename: Per
authors.initials: P
authors.lastname: Hansson
authors.forename: Troels S
authors.initials: TS
authors.lastname: Jensen
authors.forename: Andrew S C
authors.initials: ASC
authors.lastname: Rice
authors.forename: Märta
authors.initials: M
authors.lastname: Segerdahl
authors.forename: Jordi
authors.initials: J
authors.lastname: Serra
authors.forename: Soeren H
authors.initials: SH
authors.lastname: Sindrup
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Tölle
authors.forename: Rolf-Detlef
authors.initials: RD
authors.lastname: Treede
authors.forename: Christoph
authors.initials: C
authors.lastname: Maier
mesh_terms: D000328:Adult; D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold; D059348:Peripheral Nerve Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D011115:Polyneuropathies / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult