Bedside Sensory Testing A set of standardized procedures using standardized equipment to conduct basic sensory testing with minimum cost and patient burden.

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Presentation transcript:

Bedside Sensory Testing A set of standardized procedures using standardized equipment to conduct basic sensory testing with minimum cost and patient burden ‘Kits’ have been developed and partially validated with procedures and equipment for osteoarthritis (OA) and post-herpetic neuralgia (PHN)

BST Procedures Local pressure pain threshold (PPT) Distal PPT Cold allodyia Mechanoreceptive function (light touch threshold; LTT) Tourniquet test (for diffuse noxious inhibitory control; DNIC) PHN only Punctate hyperalgesia Dynamic mechanical allodynia Temporal summation (wind-up)

Can DNIC predict analgesic efficacy of naproxen? OA subjects with dysfunctional DNIC showed greater discrimination of naproxen from placebo. Consistent with Yarnitsky’s (2012) report that poor DNIC function predicted response to duloxetine in PHN. P<.001 SES=.43 P<.05 SES=.34 P<.001 SES=.77

Can DNIC predict analgesic efficacy of milnacipran? OA subjects’ DNIC made no difference in open-label treatment with milnacipran (double-blind period showed no efficacy net vs. placebo either) P<.001

Value of Standardized BST Variation in sensory testing procedures increases error. Solution: standardization Many new treatments only demonstrate superiority in a sub-population. Solution: identify mechanisms for targeted treatment RPC study underway using BST with PHN Different tests in the BST toolbox may predict efficacy of different treatments in different populations