327: Reliability of QST Investigation in Healthy Caucasian Participants Living in Different Climates

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: The consistent quality of quantitative sensory testing (QST) data of healthy participants according to the German Research Network on Neuropathic Pain (DFNS) protocol within European centers was a crucial prerequisite for comparing QST data between centers and performing multicenter QST-based studies [1]. To comply the QST Thai reference data with the German reference data, it was essential to evaluate the quality of QST performance. The study aims were to find the reliability of a Thai investigator in performing QST investigations and the effects of living in different climates on the QST parameters of healthy Caucasian participants (HCPs) compared to the German normative values.

Methods: Healthy Caucasian participants (HCPs) were recruited according to a consensus statement by the EUROPAIN and NEUROPAIN consortia [2]. Standardized QST examinations on one dorsal hand of HCPs in London (temperate climate) were conducted and parallelly performed twice on both dorsal hands and one dorsal foot within one week apart in different Caucasian participants based in Bangkok (tropical climate) by a trained Thai investigator (SN). QST parameters were converted to z-scores and compared to the German normative values by EQUISTA Software. The reliability tests were calculated using intra-class correlation coefficient (ICC, two-way mixed effect model, absolute agreement, and single measurement). Then, two-way repeated measures ANOVA and post hoc pairwise comparisons were used to find the effects of living in different climates on QST parameters concerning the factors of measured sites (hand vs foot) and time (session 1 vs session 2).

Results: There were 10 HCPs in London (4 females) while 16 participants based in Bangkok (6 females). The QST results of the dorsal hand of each HCP in London compared to the German reference data were in the range of healthy [1,3,4]. Investigations of QST parameters on those based in Bangkok showed moderate to excellent correlation of intra-rater reliability in both sessions (right hands vs left hands and all hands vs feet). Intra-rater reliability of QST z-scores was better across 7 parameters of hands and 8 parameters of feet out of 11 z-scores of QST parameters in session 2, compared to session 1, with TSL showing the largest change. No PHS or DMA was found. The test-retest reliability was moderate to good. Analysis with ANOVA indicated statistical significance (p<0.05) in CDT, CPT, MDT and VDT and post-hoc pairwise comparisons revealed small magnitudes of statistical significance, which might not have clinical significance.

Conclusions: Reliability of investigation of standardized QST on healthy adult Caucasian participants by a Thai investigator was acceptable. There were no significant effects of living in different climates on the QST parameters of healthy Caucasian participants.

References: 1. Vollert J, Attal N, Baron R, Freynhagen R, Haanpää M, Hansson P, Jensen TS, Rice AS, Segerdahl M, Serra J, Sindrup SH, Tölle T, Treede RD, Maier C. Quantitative sensory testing using DFNS protocol in Europe: an evaluation of heterogeneity across multiple centers in patients with peripheral neuropathic pain and healthy subjects. PAIN 2016; 157:750-8.
2. Gierthmühlen J, Krumova EK, Attal N, Bouhassira D, Cruccu G, Finnerup NB, Haanpää M, Hansson P, Jensen TS, Freynhagen R, Kennedy JD, Mainka T, Rice AS, Segerdahl M, Sindrup SH, Serra J, Tölle T, Treede RD, Baron R, Maier C. Who is healthy? Aspects to consider when including healthy volunteers in QST-based studies-a consensus statement by the EUROPAIN and NEUROPAIN consortia. PAIN 2015;156:2203-11.
3. Magerl W, Krumova EK, Baron R, Tölle T, Treede RD, Maier C. Reference data for quantitative sensory testing (QST): refined stratification for age and a novel method for statistical comparison of group data. PAIN 2010;151:598-605.
4. Vollert J, Mainka T, Baron R, Enax-Krumova EK, Hüllemann P, Maier C, Pfau DB, Tölle TR, Treede RD. Quality assurance for Quantitative Sensory Testing laboratories: development and validation of an automated evaluation tool for the analysis of declared healthy samples. PAIN 2015;156:2423-30.

Presenting Author: Supranee Niruthisard
Submitting Author: Supranee Niruthisard

Senior Author: Andrew SC Rice

IASP 2026 Global Year theme of Neuropathic Pain: No

• Supranee Niruthisard: MD - Department of Anesthesiology, Pain Management Unit, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
• Jan Vollert: PhD - Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom; Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
• Harriet Kemp: PhD, FRCA - Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
• Patt Pannangpetch: MD - Department of Anesthesiology, Pain Management Unit, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
• Yuda Chongpison: PhD, MS, MBA - Biostatistics Excellence Centre, Research Affairs, Chulalongkorn University, Bangkok, Thailand; The Skin and Allergy Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
• Andrew SC Rice: MD, FRCP, FRCA, FFPMRCA, FFPMCAI(Hon), FRSB - Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
• Rolf-Detlef Treede: MD, PhD, Prof. Dr. med - Department of Neurophysiology and Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany