Intraoral QST – Mission impossible or not?

Peter Svensson

doi:10.1016/j.sjpain.2017.04.066

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Intraoral QST – Mission impossible or not?

Peter Svensson

Published/Copyright: July 1, 2017

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From the journal Scandinavian Journal of Pain Volume 16 Issue 1

In this issue of the Scandinavian Journal of Pain, Moana-Filho and colleagues report on multifactorial assessment of measurement errors related to the reliability of intraoral Quantitative Sensory Testing (QST) [1]. First of all, the authors should be applauded for their attempt to move intraoral QST forward by looking at intra-examiner reliability between four examiners in a comprehensive (and impressive) statistical model. The main contribution is that intraoral QST, indeed, is feasible and now with a slightly better understanding of key performance parameters such as intraexaminer reliability with four examiners. The authors argue that the relatively small number of test participants, and the choices only to look at a limited number of a standardized QST modalities and a few test regions are minor concerns and I will tend to agree. Why? Because overall the study will stand as another confirmatory piece of evidence in favour of the clinical applicability of intraoral QST. And that is important to highlight – and to publish.

1 Intraoral Quantitative Sensory Testing (QST) in the Nordic countries and IASP

QST has a long tradition and in particular Scandinavian researchers have made important contributions to the field (e.g. [2]). Most noticeably, also intraoral and extraoral QST has been developed over the last 3 decades (e.g. [3, 4, 5]). A major milestone in intraoral QST was the consensus report endorsed by the Special Interest Group on Orofacial Pain under IASP that intraoral QST should follow standardized guidelines and stimulation techniques and recording of psychophysical responses should be meticulously described and controlled [6]. The recommendation was to follow the general trend in QST spearheaded by the German Research Network on Neuropathic Pain (DFNS) with a comprehensive battery of different stimulus modalities to create a somatosensory profile of the patient 7]. A series of studies from our research group has subsequently examined the test–retest reliability in addition to intra-examiner reliability with the overall result that all tests are sufficiently reliable and reproducible [8, 9, 10].

2 QST in atypical odontalgia (AO), temporomandibular disorders (TMD), and more

As a unique study, even the test–retest reliability was tested in patients with the enigmatic diagnosis of “atypical odontalgia” [10]. Case–control studies have since applied these intra- and extraoral QST techniques to provide somatosensory profiles of AO and (TMD) patients [11, 12, 13, 14]. Also a series of experimental and surrogate pain models have been tested with the developed QST techniques [15, 16, 17, 18]. In addition several studies with shorter QST protocols or with qualitative sensory tests or semi-quantitative tests have demonstrated the usefulness of such techniques to better understand somatosensory function under experimental modulation of normal physiological conditions or in pathological pain states [19-23]. Indeed intraoral QST techniques can be refined and even applied to the teeth [24, 25, 26].

3 Importance of intraoral QST

In this perspective, the Moana-Filho et al. study [1] is yet another step forward in our understanding of the advantages and limitations of intraoral QST. It seems fair to conclude that intraoral QST today is a distinct option for researchers and clinicians to carefully check somatosensory function in health and in pathological conditions. This may be important information to disseminate to other health care providers and medical colleagues: Yes – dentists can perform a reliable intraoral QST examination! Mission possible!

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2017.03.007.

Department of Dentistry and Oral Health, Section of Orofacial Pain and Jaw Function, Aarhus University, Vennelyst Boulevard 9, Building 1611, 344, 8000 Aarhus C, Denmark. Tel.:+4587168132; mobile:4524633009.

Conflict of interest: None declared.

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Published Online: 2017-07-01

Published in Print: 2017-07-01

Articles in the same Issue

https://doi.org/10.1016/j.sjpain.2017.04.066