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5. QST in patients with tendinopathy are adequate (Visentini et al 1998; Zwerver et al 2009). Healthy control athletes were recruited from local sports clubs and through advertisements on websites. Inclusion criteria for participation of this study were a VISA-P score had to be above 90. All subjects were asked neither to take analgesics 24h before participation in the study nor to take part in sport activities on the day of the study. Subjects with diseases or conditions associated with possible altered somatosensory function, such as a knee surgery, diabetes, fibromyalgia or neurological diseases were excluded. All participants signed an informed consent prior to their inclusion QST testing was approved by the Medical Ethical Commission (Stichting Beoordeling Ethiek Bio-Medisch Onderzoek Assen, The Netherlands). 2.2. Quantitative Sensory Testing QST entails the measurement of the subjects’ responses to standardized thermal and mechanical stimuli. QST is used to determine detection, disappearances and pain thresholds. The German Research Network on Neuropathic Pain – DFNS has developed a standardized QST protocol. This protocol consists of 7 different tests that measure 13 parameters, including various types of mechanical and thermal detection and pain thresholds for the hand, foot and face (Rolke et al 2006a). QST was performed by two research nurses, who had undergone a comprehensive training at the DNFS in Germany. All tests were performed in the same research facility. Thermal QST tests were performed using the Medoc Pathway System (Medoc, Israel) and consisted of threshold assessments for warm and cold detection (WDT, CDT) and heat pain and cold pain (HPT, CPT). Thermal measurements were obtained with ramped stimuli (1 ˚C/s) that were terminated when the subject pressed a button. Minimal and maximal temperatures were 0 and 50 ˚C. The baseline temperature was 32 ˚C. In addition, subjects were asked about paradoxical heat sensations (PHS) during the thermal sensory limen (TSL) procedure of alternating warm and cold stimuli. Mechanical QST tests consisted of seven different parameters. The mechanical detection threshold (MDT) was determined with a standardized set of modified von Frey filaments (Optihair2-Set, Marstock Nervtest, Germany). The mechanical pain threshold (MPT) was measured using a set of seven pinprick devices with fixed stimulus intensities that exerted forces of 8, 16, 32, 64, 128, 256, and 512 mN. Mechanical pain sensitivity (MPS) was assessed using the same set of seven weighted pinprick stimuli to obtain a stimulus–response function for pinprick-evoked pain. Dynamic mechanical allodynia (DMA) was assessed as part of the test above, using a set of three light tactile stimulators as dynamic innocuous stimuli: cotton wisp, cotton wool tip fixed to an elastic strip and a standardized brush (SENSElab No.5 Somedic, Sweden). Vibration disappearance threshold (VDT) was performed with a Rydel–Seiffer graded tuning fork (64 Hz, 8/8 scale) that was placed on the patellar tendon; the vibration is graded from 0 to 8 (max). The wind up ratio (WUR) test was assessed with a pinprick intensity
5. QST in patients with tendinopathy of 256 mN. The pressure pain threshold (PPT) was determined with a pressure gauge device (FDN200, Wagner Instruments, CT, USA). All PT patients and healthy controls were tested on the patellar tendon, directly distal to the apex of the patella. 2.3. Questionnaires The DN-4 (Douleur Neuropathique 4 questions) was assessed in the patients with PT in order to assess the presence of neuropathic pain symptoms. The ‘classical’ DN4questionnaire contains 10 items; the first 7 items, called the DN4-interview, are sensory descriptors that may be applicable to the patient’s pain, the remaining 3 items are related to physical examination signs; touch hypoestesia, pricking hypesthesia and brushing. Since we assessed a physical examination through the QST protocol, we only used the 7-items DN-4-interview. For each positive item on the DN-4, one point is assigned. The cut-off score for neuropathic pain of the DN-4 interview was set at 4 or more positive items (Bouhassira et al 2005). The results from the ‘classical’ DN4-questionnaire have been compared with the diagnoses of expert clinicians, DN-4 showed 83% sensitivity and 90% specificity and the DN4-interview demonstrated similar results (Bouhassira et al 2005). Since psychological factors may interfere with pain perception, two psychological questionnaires were included. All participants filled out the Symptom Check List-90 (SCL-90) and the Profile of Mood States (POMS). The SCL-90 is a multidimensional self-report inventory to assess various current psychological symptoms. The SCL-90 yields 9 symptom domains of which the dimensions phobic anxiety, anxiety, depression, somatisation, insufficiency of thinking and acting, interpersonal sensitivity, hostility and quality of sleep were used in this study. Participants were asked to rate on a 5point scale from 1 (not at all) to 5 (extreme) how much each item had distressed or bothered them during the last 7 days, including the day of the examination. The SCL- 90 is a questionnaire that is used world-wide, the psychometric properties have been considered adequate (Arrindel & Ettema 2003). Furthermore the Dutch revised version of the (POMS) was used (Robinson et al 2001). The POMS has been used extensively over the last years to understand the emotional responses to injuries (Wiese-Bjornstal et al 1998) as well as to understand the relation between pre-competitive mood states and athletic performance (LeUnes 2002). Originally the POMS consisted of 65 items; after factor analysis, support was found for a shortened version with 24 items and 6 dimensions (Wicherts & Vorst 2004). For the Dutch POMS however, support was found for 5 domains and 32 items, namely: negative mood depression (8 items), anger (7 items), fatigue (6 items), positive mood vigour (5 items), and tension (6 items), with adequate reliability and validity (Wicherts & Vorst 2004).
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Quantitative Sensory Testing (QST)
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Promotores: Prof. dr. M.M.R.F. Stru
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Paranimfen Marten Harbers Aribert B
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Contents 3.3.4. Sensory changes at
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0 Contents Chapter 5 Do patients wi
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Chapter 1 General introduction
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1. General introduction stimuli. C-
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1. General introduction Patients re
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1. General introduction 0 drugs (NS
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1. General introduction Table 1-2:
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Chapter 2 Bilateral sensory abnorma
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2. Bilateral abnormalities in neuro
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Page 106 and 107: References Abate M, Silbernagel KG,
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Page 110 and 111: Kehlet H, Jensen TS, Woolf CJ. 2006
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Page 114 and 115: Visentini PJ, Khan KM, Cook JL, Kis
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Page 118 and 119: Acknowledgement To produce a work s
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