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Ranking of Tests for Pain Hypersensitivity According to Their Discriminative Ability in Chronic Neck Pain
  1. Alban Y. Neziri, MD*,,
  2. Andreas Limacher, MD,
  3. Peter Jüni, MD,§,
  4. Bogdan P. Radanov, MD,
  5. Ole K. Andersen, MD#,
  6. Lars Arendt-Nielsen, MD# and
  7. Michele Curatolo, MD, PhD*#
  1. *University Department of Anesthesiology and Pain Therapy, Bern University Hospital, Inselspital, Bern; Department of Obstetrics and Gynecology, Cantonal Hospital of St Gallen, St Gallen; Clinical Trials Unit, Department of Clinical Research, and §Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern; Pain Unit, Clinic Wilhelm Schulthess, Zurich, Switzerland; and #Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
  1. Address correspondence to: Michele Curatolo, MD, PhD, University Department of Anesthesiology and Pain Therapy, University Hospital of Bern, Inselspital, 3010 Bern, Switzerland (e-mail: michele.curatolo{at}


Background and Objectives Quantitative sensory testing (QST) is widely used to investigate peripheral and central sensitization. However, the comparative performance of different QST for diagnostic or prognostic purposes is unclear. We explored the discriminative ability of different quantitative sensory tests in distinguishing between patients with chronic neck pain and pain-free control subjects and ranked these tests according to the extent of their association with pain hypersensitivity.

Methods We performed a case-control study in 40 patients and 300 control subjects. Twenty-six tests, including different modalities of pressure, heat, cold, and electrical stimulation, were used. As measures of discrimination, we estimated receiver operating characteristic curves and likelihood ratios.

Results The following quantitative sensory tests displayed the best discriminative value: (1) pressure pain threshold at the site of the most severe neck pain (fitted area under the receiver operating characteristic curve, 0.92), (2) reflex threshold to single electrical stimulation (0.90), (3) pain threshold to single electrical stimulation (0.89), (4) pain threshold to repeated electrical stimulation (0.87), and (5) pressure pain tolerance threshold at the site of the most severe neck pain (0.86). Only the first 3 could be used for both ruling in and out pain hypersensitivity.

Conclusions Pressure stimulation at the site of the most severe pain and parameters of electrical stimulation were the most appropriate QST to distinguish between patients with chronic neck pain and asymptomatic control subjects. These findings may be used to select the tests in future diagnostic and longitudinal prognostic studies on patients with neck pain and to optimize the assessment of localized and spreading sensitization in chronic pain patients.

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  • The study was funded by the Swiss National Science Foundation (3247BO_122358/1), the Danish Research Council for Technology and Production, the Scientific Funds of the University Department of Anesthesiology and Pain Therapy of the University of Bern, the Foundation for Research in Anaesthesia and Intensive Care of the University Hospital of Bern. CTU Bern is supported by the Swiss National Science Foundation.

    Preliminary results from this study were presented at the 14th World Congress on Pain, August 2012, in Milan, Italy; at the Annual Congress of the Swiss Association for the Study of Pain, August 2012, in Nottwil, Switzerland; and at the Congress of the Swiss Society of Anaesthesiology and Reanimation, November 2012, in Basel, Switzerland.

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