The variability in thermal threshold-assessments in post-thoracotomy pain syndrome

Background/aims: Quantitative sensory testing (QST) is a reference method in characterization of neuropathic pain components. Variability data on thermal thresholds have been presented for a number of diseases, but not for patients with persistent post-surgical pain. Thus, the objectives of the present study were to assess the day-to-day variation, but also topographic variability in thermal threshold assessments in post-thoracotomy pain syndrome (PTPS) patients. The variability in thermal thresholds between pre-specified sites, on the surgical and the non-surgical side were compared to each other and to the area of maximum pain. Patients and methods: Fourteen PTPS patients were included. Dynamic sensory mapping was performed with a 25 °C metal roller (cool). Within the area of cool sensory dysfunction on the surgical side (thorax), 4 peripheral locations were marked including the maximum pain area. Similarly 4 identical peripheral but contralateral sites on the non-surgical side were also marked. Warmth detection threshold (WDT), cool detection threshold (CDT) and heat pain threshold (HPT) were assessed on day1 and day2, separated by 12 days for all marked locations. Results: Comparisons of test-retest thermal assessments (day 1–day 2), did not demonstrate any significant intra-side differences. The 99% confidence intervals for WDT ranged between 32.6 and 46.6°C, for CDT between 20.2–30.5 °C and for HPT between 37.9–51.5 °C. Within-patient and between-patient variances consisted of 5 to 28% and 73 to 95%, respectively of the total variance. Side-to-side comparisons displayed higher thresholds on the surgical side Conclusion: In patients with PTPS, different statistical methods indicated an excessively high variability in thermal thresholds, in particular for between-patient variance. This may suggest an advantage in using patients as ‘self-controls’ for assessment of thermal thresholds. However, due to the low within-patient variance, our study could still demonstrate highly significantly increases in thermal detection thresholds, within the area of cool sensory dysfunction, on the surgical side compared to the contralateral side. Also, static and dynamic assessments of thermal perception seem to indicate considerable wide-spread loco-regional changes on the side of surgery, an important finding when deciding where to assess thermal thresholds.

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• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch

References and Relationships

• Bibliographic citation: The variability in thermal threshold-assessments in post-thoracotomy pain syndrome ; volume:3 ; number:3 ; year:2012 ; pages:188-189 ; extent:2 ; Scandinavian journal of pain ; 3, Heft 3 (2012), 188-189 (gesamt 2)

Contributors, Places and Time

• Creator: Wildgaard, Kim ; Ringsted, Thomas K. ; Kehlet, Henrik ; Werner, Mads U.

Further information

• DOI: 10.1016/j.sjpain.2012.05.042
• URN: urn:nbn:de:101:1-2024022313593658237335
• Rights: Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.