Quantitative Sensory Testing
DESCRIPTION
Quantitative sensory testing (QST) systems have been proposed for the noninvasive assessment and quantification of sensory nerve function in individuals with symptoms of, or the potential for neurologic damage or disease. Types of sensory testing include current perception threshold testing, pressure-specified sensory testing (PSST), vibration perception testing, and thermal sensory testing. Information on sensory deficits identified using QST has been used in research settings to understand neuropathic pain better.
QST has not been established for use as a sole tool for diagnosis and management but has been investigated in conjunction with standard evaluation and management procedures (e.g., physical and neurological examination, monofilament testing, pinprick, grip and pinch strength, Tinel, Phalen and Roos sign) to attempt to enhance the diagnosis and treatment planning process and confirm physical findings with quantifiable data. Stimuli used in QST includes touch, pressure, pain, thermal (warm and cold), or vibratory stimuli.
Depending on the type of stimuli used, QST purportedly can assess both small and large fiber dysfunction. Touch and vibration measure the function of large, myelinated A alpha and A beta sensory fibers (e.g., Vibration Perception Threshold [VPT] METER). Thermal stimulation devices are used to evaluate pathology of small myelinated and unmyelinated nerve fibers. They can be used to assess heat and cold sensation, as well as thermal pain thresholds testing (Contact Heat-Evoked Potential Stimulator, CHEPS). Pressure-specified sensory devices assess large myelinated sensory nerve function by quantifying the thresholds of pressure detected with light, static, and moving touch (e.g., NK Pressure-Specified Sensory Device™, AP-4000, Air Pulse Sensory Stimulator). Another type of sensory nerve conduction threshold test is current perception threshold testing, which involves the quantification of the sensory threshold to transcutaneous electrical stimulation (e.g., Neurometer®, Neural-Scan™).
POLICY
Quantitative sensory testing (e.g., pressure-specified sensory testing, vibration perception threshold testing, thermal threshold testing, and current perception threshold testing) is considered investigational.
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ADDITIONAL INFORMATION
Published studies show a wide variety of sensitivity and specificity and are insufficient to demonstrate that evaluation by quantitative sensory testing can predict clinical events.
SOURCES
Abraham, A., Albulaihe, H., Alabdali, M, Qrimli, M., Breiner, A., Barnett, C., et al. (2015). Elevated vibration perception thresholds in CIDP patients indicate more severe neuropathy and lower treatment response rates. PLOS ONE, 10 (11), e0139689. (Level 4 evidence)
American Academy of Neurology. (2003; reaffirmed 2022). Quantitative sensory testing. Neurology, 60 (6), 898-904. Retrieved June 1, 2023 from http://n.neurology.org/content/60/6/898.full.
American Diabetes Association (2023). 12. Retinopathy, neuropathy, and foot care: Standards of medical care in diabetes - 2023 diabetes care, 46 (Suppl 1), S203–S215. Retrieved June 1, 2023 from http://www.diabetes.org.
Anand, P., Privitera, R., Yiangou, Y., Donatien, P., Birch, R., & Misra, P. (2017). Trench Foot or Non-Freezing Cold Injury as a Painful Vaso-Neuropathy: Clinical and Skin Biopsy Assessments. Frontiers in Neurology, 8, 514. (Level 4 evidence)
Arant, K R., Katz, J N., & Neogi, T. (2022). Quantitative sensory testing: identifying pain characteristics in patients with osteoarthritis. Osteoarthritis and Cartilage, 30 (1), 17-31. (Level 5 evidence)
BlueCross BlueShield Association. Evidence Positioning System. (7:2022). Quantitative sensory testing (2.01.39). Retrieved June 1, 2023 from www.bcbsaoca.com/eps/. (23 articles and/or guidelines reviewed)
Centers for Medicare & Medicaid Services. CMS.gov. NCD for Sensory nerve conduction threshold tests (sNCTs) (160.23). Retrieved August 17, 2016 from https://www.cms.gov.
den Bandt, H.L., Paulis, W.D., Beckwee, D., Ickmans, K., Nijs, J., & Voogt, L. (2019). Pain mechanisms in low back pain: A systematic review with meta-analysis of mechanical quantitative sensory testing outcomes in people with nonspecific low back pain. Journal of Orthopaedic Sports Physical Therapy, 49 (10), 698-715. Abstract retrieved April 7, 2021 from PubMed database.
Fabry, V., Gerdelat, A., Acket, B., Cintas, P., Rousseau, V., Uro-Coste, E., et al. (2020). Which method for diagnosing small fiber neuropathy? Frontiers in Neurology, 11, 342. (Level 4 evidence)
Ferdousi, M., Kalteniece, A., Azmi, S., Petropoulos, I. N., Worthington, A., D'Onofrio, L., et al. (2020). Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy. BMJ Open Diabetes Research & Care, 8 (2), e001801. (Level 2 evidence)
Forstenpointner, J., Ruscheweyh, R., Attal, N., Baron, R., Bouhassira, D., Enax-Krumova, E. K., et al. (2021). 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, 162 (3), 718-727. (Level 4 evidence)
Georgopouos, V., Akin-Akinyosoye, K., Zhang, W., McWilliams, D.F., Hendrick, P., Walsh, D.A., et al. (2019). Quantitative Sensory Testing (QST) and predicting outcomes for musculoskeletal pain, disability and negative affect: a systematic review and meta-analysis. Pain, 160 (9), 1920-1932. (Level 1 evidence)
U. S. Food and Drug Administration. (1997, December). Center for Devices and Radiological Health. 510k Pre-market Notification Database. K964622. Retrieved July 2, 2018 from http://www.accessdata.fda.gov.
U. S. Food and Drug Administration. (1997, September). Center for Devices and Radiological Health. 510k Premarket Notification Database. K964815. Retrieved July 2, 2018 from http://www.accessdata.fda.gov.
Van der Cruyssen, F., Van Tieghem, L., Croonenborghs, T-M., Baad-Hansen, L., Svensson, P., Renton, T., et al. (2020). Orofacial quantitative sensory testing: Current evidence and future perspectives. European Journal of Pain, 24 (8), 1425-1439. (Level 4 evidence)
ORIGINAL EFFECTIVE DATE: 1/14/2006
MOST RECENT REVIEW DATE: 7/13/2023
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