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Representative Results






A Protocol of Manual Tests to Measure Sensation and Pain in Humans

Published: December 19th, 2016



1Chronic Pain Research Consortium, Duquesne University, 2Department of Physical Therapy, Duquesne University, 3Department of Biological Sciences, Duquesne University, 4Department of Psychology, Duquesne University, 5Department of Occupational Therapy, Duquesne University

The goal of this procedure is to demonstrate a battery of quantitative techniques for sensory and pain measurement in humans. The equipment and techniques described are commonly found in pain clinics or are easy to obtain.

Numerous qualitative and quantitative techniques can be used to test sensory nerves and pain in both research and clinical settings. The current study demonstrates a quantitative sensory testing protocol using techniques to measure tactile sensation and pain threshold for pressure and heat using portable and easily accessed equipment. These techniques and equipment are ideal for new laboratories and clinics where cost is a concern or a limiting factor. We demonstrate measurement techniques for the following: cutaneous mechanical sensitivity on the arms and legs (von-Frey filaments), radiant and contact heat sensitivity (with both threshold and qualitative assessments using the Visual Analog Scale (VAS)), and mechanical pressure sensitivity (algometer, with both threshold and the VAS). The techniques and equipment described and demonstrated here can be easily purchased, stored, and transported by most clinics and research laboratories around the world. A limitation of this approach is a lack of automation or computer control. Thus, these processes can be more labor intensive in terms of personnel training and data recording than the more sophisticated equipment. We provide a set of reliability data for the demonstrated techniques. From our description, a new laboratory should be able to set up and run these tests and to develop their own internal reliability data.

Chronic pain conditions are a worldwide clinical problem. More than 1.5 billion people worldwide suffer from chronic pain, and approximately 5% of the global population suffers from neuropathic pain, with incidence rates increasing with age1. In America, it is estimated that pain affects more people than diabetes, heart disease, and cancer, combined2. While awareness of this problem is increasing, treatments are not always successful, can be expensive, and may have serious side effects, including addiction. Research on treatments is ongoing, but as pain varies greatly between individuals, pain measurement for research or diagnosis can be problema....

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All tests with human subjects should be approved by the Institutional Review Board at the individual institution. All testing described for the current study was approved by the Duquesne University Institutional Review Board for human subject research. Training for and descriptions of each measure are as follows:

1. Cutaneous Mechanical Sensitivity Assay13

NOTE: Enrolled participants are asked to sit in a chair, with support provided for the extremity to be.......

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 Here, we describe the implementation of cost-effective qualitative and quantitative assays to measure innocuous sensation and pain in human participants using the VAS (Figure 2). The visual representation is important, because accurate and precise results of these examinations are dependent upon correct and consistent protocol execution by the technician. Additionally, it is valuable to know if multiple technicians performing the technique as described can collect r.......

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We have demonstrated cost-effective and simple qualitative and quantitative sensory tests that can be used to assess mechanical sensation, thermal sensation and pain, and pressure pain in human subjects. The value of these assays is their ease of implementation and low amount of necessary training time. Each experimenter received a minimal amount of training (one trial observation and one trial implementation). Thus, multiple technicians could be trained in one day. The results suggest strong inter-experimenter and withi.......

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The authors acknowledge the following funding sources: the Duquesne University Faculty Development Fund grants awarded to Kimberly Szucs, PhD and Alex Kranjec, PhD and to Benedict Kolber, PhD and Matthew Kostek, PhD. We also acknowledge Rachel Sweetnich for experimental assistance and funding from the Duquesne University Pain Undergraduate Research Experience program awarded to Sweetnich (Mentors: Szucs and Kostek).


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Name Company Catalog Number Comments
Pressure Algometer / Force Dial Wagner Instruments FDK 20 The pressure algometer quantifies pressure pain threshold.  It has a rubber tip attachment that is applied to the marked skin site by the investigator.  The dial records the pressure and is reset after each measurement.
von Frey cutaneous stimulators Touch Test NC1275-01 through -08 These von Frey filaments are commonly used to examine sensitivity in research and clincial settings.  Our set of 8 filaments covers a range of sensitivites.  The individual filaments are 1.65 mN, 2.36 mN, 2.44 mN, 2.83 mN, 3.22 mN, 3.61 mN, 3.84 mN, 4.08 mN.
"Hargreaves" apparatus, testing platform Custom n/a One complete base and four supporting columns are used to form a platform for a sheet of safety glass through which the heat source directs heat to the subjects arm or leg that is resting on the glass.  The heat lamp is placed beneath the glass.
0.64cm Pyrex safety glass DuPont n/a Safety glass is important to avoid injury in the unlikely event of a fracture in the glass surface.
Electronic thermometer / thermocouple 53 IIB Fluke 3821062 The thermocouple is used for thermal testing.  The thermocouple is placed on the glass underneath the subject's arm or leg and measures the temperature at the glass level.
IITC Plantar Analgesia Meter  Life Science Inc. Woodland Hills, CA 390 This is the heat source and timer for Hargreaves testing.  The unit's heat source has an “idle state” that allows exact placement of the heat source.  The heat source is radiant light and the light beam is focused to the top of the glass to creates a 4X6mm intense spot on the arm or leg.
Examiner script Custom n/a A written script for the examiner is used for every testing session.  Because pain and sensitivity can be affected by envrionmental stresses, we attempt to maintain as much consistency as possible between subjects.  The examiner reads directly from the script every time a measure is made to ensure  verbal consistency.
Markers for testing site Sharpie n/a Washable markers may be preferable for situations where multiple days of testing is not necessary
Constant heat stimulus block Benchmark Scientific BR10-00 This block is digitally controlled. The surface of the block is 2x3cm.

  1. Analysts, G. I. Pain Management - A Global Strategic Business Report. Global Industry Analysts. , 727 (2012).
  2. Medicine, A. .. A. .. o. .. P. . AAPM Facts and Figures on Pain. , (2015).
  3. Loeser, J. D., Treede, R. D. The Kyoto protocol of IASP Basic Pain Terminology. Pain. 137 (3), 473-477 (2008).
  4. Clauw, D. J. Fibromyalgia: a clinical review. JAMA. 311 (15), 1547-1555 (2014).
  5. Haanpaa, M., et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 152 (1), 14-27 (2011).
  6. Cruccu, G., et al. Recommendations for the clinical use of somatosensory-evoked potentials. Clin Neurophysiol. 119 (8), 1705-1719 (2008).
  7. Backonja, M. M., et al. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain. 154 (9), 1807-1819 (2013).
  8. Mainka, T., Maier, C., Enax-Krumova, E. K. Neuropathic pain assessment: update on laboratory diagnostic tools. Curr Opin Anaesthesiol. 28 (5), 537-545 (2015).
  9. Maier, C., et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes. Pain. 150 (3), 439-450 (2010).
  10. Magerl, W., et al. Reference data for quantitative sensory testing (QST): refined stratification for age and a novel method for statistical comparison of group data. Pain. 151 (3), 598-605 (2010).
  11. Pfau, D. B., et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): reference data for the trunk and application in patients with chronic postherpetic neuralgia. Pain. 155 (5), 1002-1015 (2014).
  12. Olesen, A. E., Andresen, T., Staahl, C., Drewes, A. M. Human experimental pain models for assessing the therapeutic efficacy of analgesic drugs. Pharmacol Rev. 64 (3), 722-779 (2012).
  13. Rolke, R., et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 10 (1), 77-88 (2006).
  14. Angst, M. S., Tingle, M., Phillips, N. G., Carvalho, B. Determining heat and mechanical pain threshold in inflamed skin of human subjects. J Vis Exp. (23), e1092 (2009).
  15. Dyck, P. J., et al. Cool, warm, and heat-pain detection thresholds: testing methods and inferences about anatomic distribution of receptors. Neurology. 43 (8), 1500-1508 (1993).
  16. Tena, B., et al. Reproducibility of Electronic Von Frey and Von Frey monofilaments testing. Clin J Pain. 28 (4), 318-323 (2012).
  17. Staahl, C., Christrup, L. L., Andersen, S. D., Arendt-Nielsen, L., Drewes, A. M. A comparative study of oxycodone and morphine in a multi-modal, tissue-differentiated experimental pain model. Pain. 123 (1-2), 28-36 (2006).
  18. Reddy, K. S., Naidu, M. U., Rani, P. U., Rao, T. R. Human experimental pain models: A review of standardized methods in drug development. J Res Med Sci. 17 (6), 587-595 (2012).
  19. Adriaensen, H., Gybels, J., Handwerker, H. O., Van Hees, J. Nociceptor discharges and sensations due to prolonged noxious mechanical stimulation--a paradox. Hum Neurobiol. 3 (1), 53-58 (1984).
  20. Burke, D., Mackenzie, R. A., Skuse, N. F., Lethlean, A. K. Cutaneous afferent activity in median and radial nerve fascicles: a microelectrode study. J Neurol Neurosurg Psychiatry. 38 (9), 855-864 (1975).
  21. Woolf, C. J., Max, M. B. Mechanism-based pain diagnosis: issues for analgesic drug development. Anesthesiology. 95 (1), 241-249 (2001).
  22. Wylde, V., Palmer, S., Learmonth, I. D., Dieppe, P. Test-retest reliability of Quantitative Sensory Testing in knee osteoarthritis and healthy participants. Osteoarthritis Cartilage. 19 (6), 655-658 (2011).
  23. Geber, C., et al. Test-retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): a multi-centre study. Pain. 152 (3), 548-556 (2011).
  24. Green, B. G. Temperature perception on the hand during static versus dynamic contact with a surface. Atten Percept Psychophys. 71 (5), 1185-1196 (2009).
  25. Green, B. G. Referred thermal sensations: warmth versus cold. Sens Processes. 2 (3), 220-230 (1978).
  26. Green, B. G., Lederman, S. J., Stevens, J. C. The effect of skin temperature on the perception of roughness. Sens Processes. 3 (4), 327-333 (1979).
  27. Stevens, J. C., Green, B. G., Krimsley, A. S. Punctate pressure sensitivity: effects of skin temperature. Sens Processes. 1 (3), 238-243 (1977).
  28. Fowler, C. J., Sitzoglou, K., Ali, Z., Halonen, P. The conduction velocities of peripheral nerve fibres conveying sensations of warming and cooling. J Neurol Neurosurg Psychiatry. 51 (9), 1164-1170 (1988).
  29. Tominaga, M., Liedtke, W. B., Heller, S. TRP Ion Channel Function in Sensory Transduction and Cellular Signaling Cascades. Frontiers in Neuroscience. , (2007).
  30. Yarnitsky, D., Ochoa, J. L. Warm and cold specific somatosensory systems. Psychophysical thresholds, reaction times and peripheral conduction velocities. Brain. 114 (Pt 4), 1819-1826 (1991).
  31. Hughes, A. M., Rhodes, J., Fisher, G., Sellers, M., Growcott, J. W. Assessment of the effect of dextromethorphan and ketamine on the acute nociceptive threshold and wind-up of the second pain response in healthy male volunteers). Br J Clin Pharmacol. 53 (6), 604-612 (2002).
  32. Handwerker, H. O., Kobal, G. Psychophysiology of experimentally induced pain. Physiol Rev. 73 (3), 639-671 (1993).
  33. Taylor, D. J., McGillis, S. L., Greenspan, J. D. Body site variation of heat pain sensitivity. Somatosens Mot Res. 10 (4), 455-465 (1993).
  34. Drury, D. G., Stuempfle, K. J., Shannon, R., Miller, J. An investigation of exercise-induced hypoalgesia after isometric and cardiovascular exercise. Journal of Exerc Physiol. 7 (4), (2004).
  35. Sternberg, W. F., Bokat, C., Kass, L., Alboyadjian, A., Gracely, R. H. Sex-dependent components of the analgesia produced by athletic competition. J Pain. 2 (1), 65-74 (2001).
  36. Yarmolenko, P. S., et al. Thresholds for thermal damage to normal tissues: an update. Int J Hyperthermia. 27 (4), 320-343 (2011).
  37. Kinser, A. M., Sands, W. A., Stone, M. H. Reliability and validity of a pressure algometer. J Strength Cond Res. 23 (1), 312-314 (2009).
  38. Portney, L. G., Watkins, M. P. . Foundations of Clinical Research: Applications to Practice. , (2009).

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