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Studies on the concurrent validity of clinically applicable testing protocols for conditioned pain modulation (CPM) and temporal summation of pain (TSP) in breast cancer survivors (BCS) with persistent pain are lacking.

Introduction: Characterizing somatosensory profiles or phenotypes in subgroups of patients may provide indirect insights into underlying pathophysiological mechanisms. The most common method for quantifying somatosensory function is quantitative sensory testing (QST). This paper describes a protocol for determining these somatosensory profiles in a breast cancer population. Methods: A standardized QST protocol is implemented including nine static and dynamic QST methods (mechanical detection-pain thresholds, pressure pain thresholds, thermal detection-pain thresholds for heat and cold, temporal summation and conditioned pain modulation) performed in the surgical area and more distant regions. After the QST assessment, distribution of the data is checked and data is transformed if necessary (raw or log-transformed data).1,2 Subsequently, QST data is z-transformed using the mean and standard deviation of a 15332500, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/papr.13128 by EBSCO SUBSCRIPTION SERVICES - Journal Digital Lic, Wiley Online Library on [19/10/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commonscontrol group as reference data. The algebraic sign of the resulting z score is adjusted appropriately for clarity of data presentation (increased-decreased sensitivity to the tested stimuli). Results: The z-scores acquired with this protocol can inform at a glance whether there is a loss or gain in somatosensory function. Findings can be visualized using a scatter or bar chart. Discussion: Although this protocol was used to determine somatosensory profiles in a breast cancer population, the methodology for determining these profiles can be applied to data from other populations as well. Process evaluation: To correctly interpret QST results, data from a reference population that matches in QST method and test site is required. The proactive development of normative databases for specific QST protocols will improve the efficiency of QST data processing in the future. [ABSTRACT FROM AUTHOR]

Introduction: To date, it is unclear which personal influencing factors need to be considered when determining normative values for pressure pain threshold (PPT). Therefore, the aim was to synthesize all studies that investigate personal factors influencing PPT in healthy people. Methods: PubMed, Web of Science, and Embase were systematically searched. Also hand-search methods were performed until the 19th May, 2021. All data was summarized and results were pooled per influencing factor, and included in a meta-analysis when sufficiently homogenous. Results: Fifty studies were eligible. Five had low, nine moderate, and 36 a high risk of bias. Most conclusions were based on a strength of recommendation level IV. Age PPT measured at shoulder/arm region, blood pressure, gender, and scapula position may influence PPT following the meta-analytic approach. Hand dominance, psychomotor function and manual work may influence PPT based on the qualitative summary. Other personal factors showed no influence or conflicting results. Discussion: Age (when PPT is measured at shoulder/arm region), blood pressure, gender, scapula position, hand dominance, psychomotor function and performing manual work are personal factors that could be considered when determining normative PPT values. However, caution is advised, because many studies were not eligible to include in meta-analyses. The performed meta-analyses had high heterogeneity, and most conclusions were weak due to high risk of bias in the included studies. More research is necessary. Process evaluation: Limitations: 20 studies were retrieved by hand-search. Difficulties: to interpret and present the results, because meta-analyses were only possible with a part of the studies. [ABSTRACT FROM AUTHOR]

Introduction: Mechanism-based approaches to pain are becoming increasingly popular in recent years. Unfortunately, mechanism-based approaches require assessment using quantitative sensory testing which is rarely available in clinical practice. Therefore, this study compared two clinically applicable test protocols for conditioned pain modulation (CPM) and temporal summation (TS) to a laboratory reference test regarded as a golden standard. Methods: Twenty breast cancer survivors (BCS) experiencing persistent pain were assessed with three different CPM and TS protocols. Two clinically applicable protocols were compared to a reference test. The CPM protocols consisted of a cold water bath or a blood pressure cuff as conditioning stimulus, with pressure pain threshold (PPT) as a test stimulus. TS was applied by using a Von Frey filament or an algometer. The TSA-2 by Medoc (Ramat Yishay, Israel) was used as a reference test for both CPM and TS. Heat was used as stimulus for both reference test protocols. Results: Strong and significant correlation was found for the two clinically applicable CPM test protocols (r > 0.802, p < 0.001). No correlation was found between the CPM reference test and the alternative CPM test protocols. In regard to TS, no correlation was found between the alternative test protocols and the reference TS test protocol. Discussion: No correlation was found between the proposed CPM and TS test protocols and their respective reference test. Process evaluation: Limitations: limited sample size, TS with TSA-2 was performed without the CHEPS thermode however protocol was based upon prior research in healthy individuals and adapted to BCS. [ABSTRACT FROM AUTHOR]