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Small Fiber Neuropathy and Related Syndromes: Pain and Neurodegeneration pp 33–42Cite as

Psychophysics: Quantitative Sensory Testing in the Diagnostic Work-Up of Small Fiber Neuropathy

Abstract

Quantitative sensory testing (QST), in particular using thermodes to apply defined warm and cold stimuli, is a well-established method to detect functional changes of Aδ- and C-fibers. Protocols have been established, and normative values have been determined in large cohorts. QST can be understood as an extension of clinical examination used to detect, confirm, and quantify subtle sensory abnormalities. Usually, thresholds for warm and cold detection, for pain induced by heat and cold, and for the detection of changes in temperature are assessed. The equipment, to date, is costly and bulky, but smaller and more affordable devices are being developed. To obtain intra- and interobserver comparability, it is important to observe a standardized method with fixed instructions given to the patient. As a psychophysical test, QST requires patient cooperation, and there may be errors due to lack of attention or malingering. Also, the range of normal is large, so that false-negative findings may result. Given these caveats, QST has been used by many groups and has been found a simple and moderately sensitive instrument to detect small fiber dysfunction both in small fiber neuropathy and in other conditions associated with damage to the small fibers. In particular, this noninvasive method can be used for intraindividual follow-up in prospective studies.

Keywords

  • Thermal detection thresholds
  • Mechanical detection thresholds
  • Pain thresholds
  • Windup
  • Diabetes mellitus
  • Fabry disease
  • Channelopathy
  • Sarcoidosis

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Fig. 4.1
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  1. Universitätsklinikum Würzburg, Würzburg, Germany

    Claudia Sommer

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Correspondence to Claudia Sommer .

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Editors and Affiliations

  1. Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan

    Prof. Dr. Sung-Tsang Hsieh

  2. Department of Neurology, Imperial College London, Hammersmith Hospital, London, UK

    Prof. Dr. Praveen Anand

  3. Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Prof. Dr. Christopher H. Gibbons

  4. Neurologische Klinik, Universitätsklinikum Würzburg , Würzburg, Germany

    Prof. Dr. Claudia Sommer

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Sommer, C. (2019). Psychophysics: Quantitative Sensory Testing in the Diagnostic Work-Up of Small Fiber Neuropathy. In: Hsieh, ST., Anand, P., Gibbons, C., Sommer, C. (eds) Small Fiber Neuropathy and Related Syndromes: Pain and Neurodegeneration. Springer, Singapore. https://doi.org/10.1007/978-981-13-3546-4_4

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