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Purpose This study aimed to assess subclinical peripheral diabetic neuropathy (PDN) in adolescents with type 1 diabetes mellitus (T1DM). Methods Subjects included 53 T1DM patients (age (mean ± SE): 15.8 ± 0.54 years, disease duration: 6.0 ± 0.51 years and HbA1c: 7.9 ± 0.19%), and 37 healthy gender matched controls (age: 15.6 ± 0.52 years). PDN was assessed by vibration perception threshold (VPT) and by quantitative sensory testing (QST). In controls, 95% confidence intervals were calculated. Results Among patients, VPT prevalence of abnormality ranged from 60–73.4% on different sites. Higher VPT was found in patients on all examined sites ( p  < 0.01). In controls, VPT correlated with height ( r  = 0.48, p  = 0.05). Regarding QST prevalence of abnormality, cold detection threshold (CDT) ranged 7.3–39.0%, cold pain threshold (CPT) ranged 22.22–29.63%, hot detection threshold (HDT) ranged 34.14–63.41%, and hot pain threshold (HPT) ranged 15.79–36.84%. In patients, CPT correlated with BMI ( r  = 0.42, p  = 0.05) and diabetes duration, ( r  = 0.40, p  = 0.05), HPT correlated with age ( r  = 0.36, p  = 0.05) and height ( r  = 0.35, p  = 0.05), while in controls with BMI ( r  = 0.51, p  = 0.05). No correlation of VPT or QST with HbA1c was observed. Conclusion Adolescents with T1DM in this study, although asymptomatic, showed a high prevalence of impaired indices of PDN, highlighting potential clinical implications of early identification of PDN.

OBJECTIVE:This study was to investigate the acute effects of hand-arm vibrations on the nerve functions of the hands, and the impact of the grip force applied to the vibrating tool during exposure. METHODS:Grip strength and perception of vibration, touch, and temperature were evaluated using quantitative sensory testing (QST) before and after vibration exposure in 21 occupationally unexposed individuals. The procedure was performed twice, with a higher grip force being applied during exposure on the second occasion. RESULTS:Vibration perception was significantly impaired after both exposures. Grip strength, perception of touch, and temperature were only significantly affected after the high grip force exposure. CONCLUSIONS:Exposure to hand-arm vibrations has acute effects on hand nerve function that are sensitive to the grip force applied during exposure.

ObjectivesThe aims were to use different techniques to assess the degree of sensory changes and magnitude of perceived size changes in the facial region induced by nerve blocks of two different trigeminal nerve branches in healthy participants.Materials and methodsThis placebo-controlled study included 30 healthy volunteers. The participants underwent quantitative and qualitative sensory testing (QST and QualST) thrice: before, 10 min, and 2 h after mental (n = 15) and infraorbital (n = 15) nerve blocks and during control (saline) sessions. Perceived numbness, temperature changes, and perceptual distortion were also measured at all time points during the nerve block and control sessions. Differences in outcome parameters between the sessions and time points were analyzed using analyses of variance and McNemar’s tests.ResultsThere was a significant degree of sensory loss to most QST and all QualST parameters, with significant numbness and increased perceived size at the injection site 10 min and 2 h after the nerve blocks compared with saline (P < 0.030) and the baseline (P < 0.042). Two hours after the nerve blocks, the sensitivity was significantly closer to baseline than after 10 min to most of the QST parameters (P < 0.011).ConclusionsQST and QualST revealed that the nerve blocks in the orofacial region resulted in complete or partial blockade of afferent nerve fibers mediating thermal and mechanical function for more than 2 h with significant numbness and perceptual distortion.Clinical relevanceBoth QST and QualST can provide information on the degree of blockade of afferent nerve fibers after nerve blocks in the orofacial region.

Pain prevention and management is one of the primary goals of dental care. Postoperative dental pain (PDP) following caries removal and performance of a restorative dental treatment is a common clinical phenomenon, often causing significant discomfort to dental patients. In the present study, a psychophysical non-invasive method, qualitative sensory testing (QualST), was used in an attempt to foretell PDP following dental restorative procedures. Forty-two dental patients underwent an intra-oral cold QualST four times: immediately prior to a restorative dental procedure and at a follow-up meeting 1–3 weeks later, on the treated and on the contralateral oral sides. The QualST measures included subjects’ evaluation of the magnitude of pain and cold sensations experienced (on visual analogue scales) and the duration of the cold sensation (in seconds). Additional measures included age, gender, level of dental anxiety, jaw treated, and type of dental restoration performed (Class I or Class V). Subjects’ PDP was assessed through the phone using numeric rating scales 24, 48, and 72 h postoperatively. The highest level of PDP experienced by subjects occurred 24 h postoperatively (ANOVA with repeated measures). Of the study variables, the QualST pain sensation (B = 0.645, p < 0.001), duration of the cold sensation (B = 0.042, p < 0.05), and an interaction between gender and dental anxiety (B = 0.136, p < 0.05) emerged as possible predictors of the highest PDP experienced by subjects (stepwise regression). The results suggest that subjects’ reaction to an intra-oral cold stimulation of the oral mucosa can serve as a potential tool to foretell postoperative dental pain following restorative dental procedures.

In this study, we investigate the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied over the left upper limb primary motor cortex (M1) on the offset analgesia (OA) phenomenon, a measure of endogenous pain modulation. In particular, we aim to determine whether rTMS influences OA differently in the forearm region, corresponding to the stimulated cortical area, compared to the trigeminal region. Twenty-two healthy volunteers underwent three experimental sessions: a baseline session without stimulation, an active rTMS session, and a sham rTMS session. Quantitative sensory testing (QST) paradigms, including warm and cold detection thresholds, heat pain threshold corresponding to a visual analogue scale (VAS) score of approximately 50–60 out of 100 (Pain50–60), and constant and offset trials, were assessed in both the forearm and trigeminal regions. The results revealed that active rTMS significantly enhanced the OA phenomenon in the forearm during the late phase, while no significant effects were observed in the trigeminal region. These findings suggest that rTMS may modulate central pain mechanisms in a body region-specific manner, potentially linked to the somatotopic organization of M1. This study points to possible mechanisms of action of rTMS for pain relief, highlighting the importance of region-specific effects in chronic pain treatment. Further research is needed to investigate the underlying mechanisms and clinical applicability of rTMS in patients with chronic pain conditions, especially when OA is compromised.

Hand-arm vibrations can cause permanent injuries and temporary changes affecting the sensory and circulatory systems in the hands. Vibrational effects have been thoroughly studied within the occupational context concerning work with handheld vibrating tools. Less is known about vibrational exposure and risk of effects during cycling. In the present study, 10 cyclists were recruited for exposure measurements of hand-arm vibrations during mountain bike cycling on the trail, and the effects on the nerve function were examined with quantitative sensory testing (QST) before and after the ride. The intervention group was compared to a control group that consisted of men exposed to hand-arm vibrations from a polishing machine. The results of the QST did not statistically significantly differ between the intervention and study groups. The intervention group showed a lesser decrease in vibration perception in digitorum II, digitorum V, and hand grip strength than the control group. It was concluded that no acute effects on nerve function in the dominant hand were measured after mountain bike cycling on the trail, despite high vibration doses through the handlebars.

Quantitative sensory testing (QST) measures have recently been shown to predict outcomes in various musculoskeletal and pain conditions. The aim of this systematic review was to summarize the emerging body of evidence investigating the prognostic value of QST measures in people with low back pain (LBP). The protocol for this review was prospectively registered on the International Prospective Register of Systematic Reviews. An electronic search of six databases was conducted from inception to October 2015. Experts in the field were contacted to retrieve additional unpublished data. Studies were included if they were prospective longitudinal in design, assessed at least one QST measure in people with LBP, assessed LBP status at follow-up, and reported the association of QST data with LBP status at follow-up. Statistical pooling of results was not possible due to heterogeneity between studies. Of 6,408 references screened after duplicates removed, three studies were finally included. None of them reported a significant association between the QST measures assessed and the LBP outcome. Three areas at high risk of bias were identified which potentially compromise the validity of these results. Due to the paucity of available studies and the methodological shortcomings identified, it remains unknown whether QST measures are predictive of outcome in LBP.

People often state that they are \"sensitive\" or \"insensitive\" to pain. However, the accuracy and clinical relevance of such statements is unclear. The aim of this study was to search for associations between self-perception of sensitivity to pain and experimental pain measures, including known psychophysical inhibitory or excitatory pain paradigms. Subjective sensitivity to pain was reported by 75 healthy participants and included three self-perceived variables: pain threshold, pain sensitivity and pain intensity in response to a hypothetical painful event (hypothetical pain intensity [HPI]). Experimental pain measures consisted of thermal pain threshold (°C), suprathreshold thermal pain intensity (Visual Analog Scale, 0-100) and the psychophysical paradigms of conditioned pain modulation (CPM) and temporal summation (TS), representing inhibitory and excitatory pain processes, respectively. No significant correlations were found between self-perceived pain threshold or pain sensitivity and any of the experimental pain measures. In contrast, the reported HPI correlated with thermal pain threshold ( = -0.282; = 0.014), suprathreshold thermal pain intensity ( = 0.367; = 0.001) and CPM ( = 0.233; = 0.044), but not with TS. Self-perception of pain sensitivity articulated by intangible expressions such as pain threshold or pain sensitivity is unrelated to actual sensitivity to experimental pain. In contrast, when measured by intensity of a hypothetical painful event (HPI), sensitivity to pain is associated with some, but not all, experimental pain reports. Further studies are needed for better understanding of these associations and their potential clinical significance.

Actinidin is a cysteine protease enzyme which occurs in kiwifruit and has been associated with improved tenderness in red meat. This study evaluated the impact of actinidin, derived from kiwifruit, on consumer sensory outcomes for striploin (M. longissimus lumborum) and outside flat (M. biceps femoris). Striploins and outside flats were collected from 87 grass-fed steers. Carcasses were graded to the Meat Standards Australia (MSA) protocols. Striploins and outside flats were then dissected in half and allocated to one of the following two treatments: (1) not infused (control) and (2) infused with a kiwifruit extract (enhanced), and then prepared as grill and roast samples. Grill and roast samples were then aged for 10 or 28 days. Consumer evaluations for tenderness, juiciness, flavor, and overall liking were conducted using untrained consumer sensory panels consisting of 2080 individual consumers, in accordance with the MSA protocols. These scores were then used to calculate an overall eating quality (MQ4) score. Consumer sensory scores for tenderness, juiciness, flavor, overall liking, and MQ4 score were analyzed using a linear mixed-effects model. Kiwifruit extract improved consumer scores for tenderness, juiciness, flavor, overall liking, and MQ4 scores for striploins and outside flat (p < 0.05). These results suggest that kiwifruit extract provides an opportunity to improve eating experiences for consumers.

This randomized double-blind controlled trial compared the block characteristics of three low-dose local anesthetics at different roots in an ultrasound-guided interscalene block, using thermal quantitative sensory testing for assessing the functioning of cutaneous small nerve fibres. A total of 37 adults scheduled to undergo shoulder arthroscopy were randomized to receive 5 mL of either 0.5% levobupivacaine with and without epinephrine 1/200,000 or 0.75% ropivacaine in a single-shot interscalene block. Thermal quantitative sensory testing was performed in the C4, C5, C6 and C7 dermatomes. Detection thresholds for cold/warm sensation and cold/heat pain were measured before and at 30 min, 6, 10 and 24 h after infiltration around C5. The need for rescue medication was recorded. No significant differences between groups were found for any sensation (lowest P = 0.28). At 6 h, the largest differences in sensory thresholds were observed for the C5 dermatome. The increase in thresholds were less in C4 and C6 and minimal in C7 for all sensations. The analgesic effect lasted the longest in C5 (time × location mixed model P < 0.001 for all sensory tests). The time to rescue analgesia was significantly shorter with 0.75% ropivacaine (P = 0.02). The quantitative sensory findings showed no difference in intensity between the local anesthetics tested. A decrease in block intensity, with minimal changes in pain detection thresholds, was observed in the roots adjacent to C5, with the lowest block intensity in C7. A clinically relevant shorter duration was found with 0.75% ropivacaine compared to the other groups. Trial registration NCT 02691442.