The Role of Quantitative Sensory Testing in Clinical Medicine and Research

Abstract

A healthy peripheral nervous system allows for perception of temperature, touch and vibration at normal levels of stimulation without hypersensitivity or pain and is a key determinant of quality of life. Quantitative sensory testing (QST) describes an array of noninvasive methods for quantifying sensory function and monitoring sensory loss among patients with or at-risk for peripheral neuropathy (PN). Like audiometry, QST quantifies patients’ subjective sensory experience with instrumentation that is precise and amenable to serial use. Thermal QST is the only diagnostic technology able to detect and quantify preclinical sensory deficit via direct patient feedback and merits wider use in clinical practice and research. A comprehensive QST assessment of 13 sensory parameters may be performed in an hour or less; abbreviated assessments take substantially less time. Although increasingly employed to evaluate sensation, define pain phenotypes, and predict outcomes in research studies and to monitor neurologic deficits in clinical practice, QST remains undervalued and underutilized possibly due to limited familiarity, experience, and understanding within the medical community and a lack of published standards regarding its use. This article is intended as a concise QST overview (with a focus on the use of thermal QST for the detection of small fiber abnormalities often associated with early PN) aimed at improving awareness of the unique role of QST in evaluating sensory function.