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Lesions in the peripheral or central nervous system can cause chronic pain ("neuropathic pain"). In this project we developed a standardized protocol of Quantitative Sensory Testing (QST) for the German Research Network Neuropathic Pain and supervise the creation of a normative database and multicenter therapy studies.
QST training
In the DFNS training center at the Department of Neurophysiology of the Mannheim Medical Faculty of the University of Heidelberg, standardized training contents are taught according to Certkom criteria. The training duration is approximately 8 hours. An assessment of the correct application of individual test stimuli is carried out at the end of the training day.
Flyer for the QST training (pdf)
Training content
- Instruction on the devices (if necessary also according to medical product law)
- Carrying out own measurements on test persons incl. computer-based evaluation
- Checking and documentation of the stimuli applied by hand
- Basics of psychophysics and clinical sensitivity testing (theoretical introduction)
- Finally, collection of findings and evaluation of data sets (exercises)
Note on point 2: The participants of the training course examine each other. The consent to undergo these examinations on oneself is a requirement for participating in the training and for obtaining a certificate of successful completion of the training.
More information under Methodology of QST
Dates
The training dates are arranged individually and take place in groups of one to four persons under the supervision of a trainer. To arrange a date, please send two to three proposed dates when all the trainees in your group are available, about one month in advance to: qst@medma.uni-heidelberg.de.
Training location
The training will take place in the Tridomus building at Ludolf-Krehl-Str. 13-17, House C, Level 4, Neurophysiology.
Costs
The costs depend on the number of participants and on the commitment of the participants to DFNS. These include the training fee excluding travel, accommodation and food costs. The duration of the training is 8 hours, spread over 1-2 days.
Price table QST training
Active members of DFNS
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1 person 875,00 €
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2 persons 875,00 € per person
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3 persons 770,00 € per person
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4 persons 700,00 € per person
This requires a membership of the direct supervisor or the person being trained in the DFNS. To receive the DFNS training rate, please send written proof of membership along with your proposed dates to qst@medma.uni-heidelberg.de
External training participants
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1 person 1.250,00 €
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2 persons 1.250,00 € per person
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3 persons 1.100,00 € per person
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4 persons 1.000,00 € per person
DFNS-affiliated institutions can receive a discount after consultation.
Payment will be made by bank transfer upon receipt of invoice.
Requirements for participation
This is a practical course. Participation in the examinations not only as an examiner, but also as a test subject in a standard test area (face, hand or foot) is therefore a prerequisite for obtaining the participation certificate. Consent to this is assumed (for further information, please refer to the section "Training contents").
All training participants must be informed in advance about the participation requirements and should have familiarized themselves with the methodology prior to the training (see literature list, at least read the publication on the methodology: Rolke et al., Eur J Pain, 2006).
Full equipment of the QST laboratory of the training participants is required (for more information, see the section "Equipment"). In order to consolidate the training contents, examinations should be conducted on 5 healthy subjects immediately after the training.
Please send us your complete contact details (incl. title) prior to the training to receive the certificate of successful training participation and for the billing address.
Contact
Mailing address
Neurophysiology
CBTM House C
Mannheim Medical Faculty of the
University of Heidelberg
Ludolf-Krehl-Str. 13-17
68167 Mannheim
Contact
PD Dr.W.Magerl
walter.magerl@medma.uni-heidelberg.de
Phone +49 621 383-71404
Sigrid Hugues, Dipl. BW (FH)
qst@medma.uni-heidelberg.de
Phone +49 621 383-7140
Dr. sc. hum. Andreas Schilder
Phone +49 621 383-3545
andreas.schilder@medma.uni-heidelberg.de
QST Device List
Equipment manufacturers for quantitative sensory testing according to the rules of the German Neuropathic Pain Research Network (DFNS):
Thermal testing
TSA 2001-II or TSA-2 from Medoc (Israel)
German general agency:
MRC Systems GmbH
Jochen Kurz and Dr Marcus Götz
Hans-Bunte-Strasse 10, 69123 Heidelberg, Germany
info@mrc-systems.de
Phone +49 6221 13 803 00
Fax +49 6221 13 803 01
www.mrc-systems.de
MSA of Somedic (Sweden)
Bo Johansson Somedic Sales AB
PO Box 194 S-242 22 Hörby, Sweden
Phone +46 415 165 50
Fax. +46 415 165 60
bo.johansson@somedic.com
Mechanical testing
Tactile detection
Von Frey-Filamente Opihair2-Set
MRC Systems GmbH
Jochen Kurz and Dr Marcus Götz
Hans-Bunte-Strasse 10, 69123 Heidelberg
info@mrc-systems.de
Phone +49 6221 13 803 00
Fax +49 6221 13 803 01
www.mrc-systems.de
Pain threshold Needlesticks
"The Pin-Prick" and equipment for allodynia testing
MRC Systems GmbH
Jochen Kurz and Dr Marcus Götz
Hans-Bunte-Strasse 10, 69123 Heidelberg
info@mrc-systems.de
Phone +49 6221 13 803 00
Fax +49 6221 13 803 01
www.mrc-systems.de
This includes the test instruments for testing dynamic mechanical allodynia and a metronome (Korg MA30) for timing the application for pain relief.
Vibrations
Tuning fork
Conventional 64 Hz tuning fork with 8/8 scale.
Pressure threshold
Pressure calliper FDN200 + rubber tip (1 cm2)
(for facial test site a finer graduated pressure algo meter is required: FDN 100) for pressure algo meters up to 2-20 kg (rubber tip must be ordered)
PO Box 1217
Greenwich, CT (USA) 06836-1217
Phone 001 203 698 9681
Fax 001 800 443 4149
www.wagnerforce.com
Electronic Pressure Gauge
Somedic Products
Frestavägen 6
Box 519
S-192 05 Sollentuna
SWEDEN
Phone +46 8 35 68 27
Fax +46 8 35 68 74
info@somedicprod.se
SOMEDIC Sales AB
Box 194
S-242 22 HÖRBY
SWEDEN
Phone +46 415 165 50
Fax +46 415 165 60
info@somedic.com
QST Methodology
Simplified description of the Quantitative Sensory Testing (QST) method (excerpt from the information sheet for QST tests on healthy volunteers)
Heat and cold
The first step is to test your sensitivity to heat and cold and your perception of cold and heat pain. This is done by placing an approx. 13 cm2 metal surface is placed on your skin. This has an initial temperature of 32°C, which will increases or decreases in a predetermined sequence. As soon as you perceive changes in temperature or pain sensations on the surface, we will ask you to press a stop button, which will return the metal surface to its initial temperature. This process will be repeated 3 times for each temperature change in each test area.
Touch
This is followed by a test of your perception thresholds for touch and needle stimuli, using a hair and a needle at different pressures on the skin. This is followed by a test to see if you experience pain when touched, known as allodynia. This is done by touching the skin with a wad of cotton wool, a Q-tip and a standardized brush, or by applying light pressure to the skin. In another test, a single stimulus is applied to the skin with a blunt needle. In an interval of ten seconds, a series of ten identical needle stimuli follows within the same skin area. Immediately after the single stimulus, as well as after the subsequent series of stimuli, an overall evaluation of the intensity of sensation will be made using a numerical scale from 0-100.
Vibration threshold
To test the vibration threshold, a tuning fork will be placed on the skin above a bony prominence (e.g. on the inner ankle for the feet, on the wrist for the hands on the head over the lateral part of the scalp).
Pressure sensitivity
To test the perception of muscular pressure sensitivity, a pressure stimulator placed over defined muscles (e.g. above the inner foot muscle for the feet, above the thumb ball for the hands, above the temple region for the face). By increasing the pressure intensity, the pressure pain threshold can be determined over the muscles.
Literature on the QST
2021 - 2016
Enax-Krumova E, Attal N, Bouhassira D, Freynhagen R, Gierthmühlen J, Hansson P, Kuehler BM, Maier C, Sachau J, Segerdahl M, Tölle T, Treede RD, Ventzel L, Baron R, Vollert J. Contralateral Sensory and Pain Perception Changes in Patients With Unilateral Neuropathy. Neurology 2021 Jul 27;97(4):e389-e402
Forstenpointner J, Ruscheweyh R, Attal N, Baron R, Didier-Bouhassira, Enax-Krumova EK, Finnerup NB, Freynhagen R, Gierthmühlen J, Hansson P, Jensen TS, Maier C, Rice ASC, Segerdahl M, Tölle T, Treede R-D, Vollert J. No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy Pain 2021 Mar 1;162(3):718-727
Meyer-Frießem CH, Attal N, Baron R, Bouhassira D, Finnerup NB, Freynhagen R, Gierthmühlen J, Haanpaa M, Hansson P, Jensen TS, Kemp H, Kennedy D, Leffler A-S, Rice ASC, Segerdahl M, Serra J, Sindrup S, Sola R, Tölle T, Schuh-Hofer S, Treede R-D, Pogatzki-Zahn E, Maier C, Vollert J. Pain thresholds and intensities of CRPS type I and neuropathic pain in respect to sex Eur J Pain 2020 Jul;24(6):1058-1071
Gierthmühlen J, Schneider U, Seemann M, Freitag-Wolf S, Maihöfner C, Enax-Krumova EK, Azad S-C, Üceyler N, Birklein F, Maier C, Tölle T, Treede R-D, Baron R. Can self-reported pain characteristics and bedside test be used for the assessment of pain mechanisms? An analysis of results of neuropathic pain questionnaires and quantitative sensory testing Pain 2019 Sep;160(9):2093-2104
Vollert J, Magerl W, Baron R, Binder A, Enax-Krumova EK, Geisslinger G, Gierthmühlen J, Henrich F, Hüllemann P, Klein T, Lötsch J, Maier C, Oertel B, Schuh-Hofer S, Tölle TR, Treede RD. Pathophysiological mechanisms of neuropathic pain: comparison of sensory phenotypes in patients and human surrogate pain models. Pain 2018 Jun;159(6):1090-1102
Vollert J, Maier C, Attal N, Bennett DLH, Bouhassira D, Enax-Krumova EK, Finnerup NB, Freynhagen R, Gierthmühlen J, Haanpää J, Hansson P, Hüllemann P, Jensen TS, Magerl W, Ramirez JD, Rice ASC, Schuh-Hofer S, Segerdahl M, Serra J, Shillo PR, Sindrup S, Tesfaye S, Themistocleous AC, Tölle T, Treede R-D, Baron R. Stratifying patients with peripheral neuropathic pain based on sensory profiles: algorithm and sample size recommendations Pain 2017 Aug;158(8):1446-1455
Baron R, Maier C, Attal N, Binder A, Bouhassira D, Cruccu G, Finnerup NB, Haanpää M, Hansson P, Hüllemann P, Jensen TS, Freynhagen R, Kennedy JD, Magerl W, Mainka T, Reimer M, Rice AS, Segerdahl M, Serra J, Sindrup S, Sommer C, Tölle T, Vollert J, Treede RD. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles Pain 2017 Feb;158(2):261-272
Vollert, J, Kramer, M, Barroso, A, Freynhagen, R, Haanpää, M, Hansson, P, Jensen, TS, Kuehler, BM, Maier, C, Mainka, T, Reimer, M, Segerdahl, M, Serra, J, Solà, R, Tölle, TR, Treede, R-D & Baron, R. Symptom profiles in the painDETECT Questionnaire in patients with peripheral neuropathic pain stratified according to sensory loss in quantitative sensory testing PAIN 2016 Aug;157(8):1810-1818
Vollert, J, Attal, N, Baron, R, Freynhagen, R, Haanpää, M, Hansson, P, Jensen, TS, Rice, ASC, Segerdahl, M, Serra, J, Sindrup, SH, Tölle, TR, Treede, R-D & Maier, C. Quantitative sensory testing using DFNS protocol in Europe: an evaluation of heterogeneity across multiple centers in patients with peripheral neuropathic pain and healthy subjects Pain, 2016 Mar;157(3):750-758
2015 - 1968
Gierthmühlen J; Enax-Krumova EK, Attal N, Bouhassira D, Cruccu G, Finnerup NB, Haanpää M, Hansson P, Jensen TS, Freynhagen R, Kennedy JD, Mainka T, Rice ASC, Segerdahl M, Sindrup S, Serra J, Tölle T, Treede RD, Baron R, Maier C. Who is healthy? Aspects to consider when including healthy volunteers in QST-based studies—a consensus statement by the EUROPAIN and NEUROPAIN consortia Pain 2015 Nov;156(11):2203-2211
Vollert J, Mainka T, Baron R, Enax-Krumova EK, Hüllemann P, Maier C, Pfau DB, Tölle T und Treede RD (2015) Quality assurance for Quantitative Sensory Testing laboratories: development and validation of an automated evaluation tool for the analysis of declared healthy samples. Pain. 156(12):2423-2430.
Pfau DB, Krumova EK, Treede RD, Baron R, Toelle T, Birklein F, Eich W, Geber C, Gerhardt A, Weiss T, Magerl W und Maier C (2014) 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):1002-15.
Pigg M, Baad-Hansen L, Svensson P, Drangsholt M, List T (2010) Reliability of intraoral quantitative sensory testing (QST). Pain. 148:220-6.
Maier C, Baron R, Tölle TR, Binder A, Birbaumer N, Birklein F, Gierthmühlen J, Flor H, Geber C, Huge V, Krumova EK, Landwehrmeyer GB, Magerl W, Maihöfner C, Richter H, Rolke R, Scherens A, Schwarz A, Sommer C, Tronnier V, Uçeyler N, Valet M, Wasner G und Treede RD (2010) 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.
Magerl W, Krumova EK, Baron R, Tölle T, Treede RD und Maier C (2010) 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.
Blankenburg M, Boekens H, Hechler T, Maier C, Krumova E, Scherens A, Magerl W, Aksu F, Zernikow B (2010) Reference values for quantitative sensory testing in children and adolescents: Development al and gender differences of somatosensory perception. Pain. 149:76-88
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