Sensory QST-profiles are not Useful for Stratifying Patients with Chronic Pain in Treatment and Clinical Trials

QST profiles are mainly based on pain thresholds - an approach developed to detect small fiber neuropathy. Sensory profiles have failed to show any link to clinical pain levels and do not identify genetically proven phenotypes in chronic pain patients.
In summary, the idea that sensory phenotypes represent certain pain mechanisms is not backed up by the data and known mechanistic factors, such as pure small fiber neuropathy, are not identified by the sensory profiles. Most of the assessed items are found within the normal range and thus, there is considerable overlap between the phenotypes and in particular between phenotypes and a normal profile. Based on the tested items, patients could be separated in small, large and mixed fiber neuropathy and thereby provide mechanistic information about the neuropathy. However, in terms of clinically relevant stratification of pain patients I agree with the 2021 paper of Forstenpointer et al in Pain: “self-reported pain does not influence the sensory profiles” - but it is this pain we are supposed to study and to treat.