Quantitative Sensory Testing in Gastrointestinal Visceral Pain: Precision Phenotyping for Personalized Treatment
DOI:
https://doi.org/10.69734/r6f3bz85Keywords:
Quantitative Sensory Testing (QST), Visceral Pain, gastrointestinal disease, chronic pancreatitis, functional dyspepsia, Irritable Bowel Syndrome, Inflammatory Bowel DiseaseAbstract
Visceral pain is one of the most common and challenging symptoms encountered in gastroenterology due to its heterogeneity in clinical presentation, etiology, and underlying mechanisms. These features also make it difficult to treat. Quantitative Sensory Testing (QST) offers a unique approach that can help identify sensory patterns that shed light on underlying mechanistic features of patients’ visceral pain experience. Though largely utilized in research and laboratory settings to date, this technique carries promise in not only identifying relevant subgroups of patients, but also potential treatment targets that could facilitate a more personalized and successful approach to the treatment of visceral pain in the future. In this review, we focus on the specific QST modalities most commonly applied across the GI disorders that cause visceral pain, provide an explanation of the reasoning and lessons learned from results to date, and identify potential treatment targets in the future.
References
Ford AC, Vanner S, Kashyap PC, Nasser Y. Chronic Visceral Pain: New Peripheral Mechanistic Insights and Resulting Treatments. Gastroenterology. 2024;166(6):976-994.
Edwards RR, Schreiber KL, Dworkin RH, et al. Optimizing and Accelerating the Development of Precision Pain Treatments for Chronic Pain: IMMPACT Review and Recommendations. J Pain. 2023;24(2):204-225.
Kuhlmann L, Olesen SS, Gronlund D, et al. Patient and Disease Characteristics Associate With Sensory Testing Results in Chronic Pancreatitis. Clin J Pain. 2019;35(9):786-793.
Zhou Q, Verne GN. New insights into visceral hypersensitivity--clinical implications in IBS. Nat Rev Gastroenterol Hepatol. 2011;8(6):349-355.
Rolke R, Baron R, Maier C, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006;123(3):231-243.
Mücke M, Cuhls H, Radbruch L, et al. Quantitative sensory testing (QST). English version. Schmerz. 2021;35(Suppl 3):153-160.
Cruz-Almeida Y, Fillingim RB. Can quantitative sensory testing move us closer to mechanism-based pain management? Pain Med. 2014;15(1):61-72.
Kuhlmann L, Olesen SS, Drewes AM. Assessment of visceral pain with special reference to chronic pancreatitis. Front Pain Res (Lausanne). 2022;3:1067103.
van Driel MEC, Huygen FJPM, Rijsdijk M. Quantitative sensory testing: a practical guide and clinical applications. BJA Educ. 2024;24(9):326-334.
Owens MA, Thomas PA, Crowe C, Goodin BR, Overstreet DS. Quantitative sensory testing for pain: What exactly are we measuring? Curr Opin Psychol. 2025;62:101988.
Singh VK, Yadav D, Garg PK. Diagnosis and Management of Chronic Pancreatitis: A Review. JAMA. 2019;322(24):2422-2434.
Bouwense SA, Buscher HC, van Goor H, Wilder-Smith OH. Has central sensitization become independent of nociceptive input in chronic pancreatitis patients who fail thoracoscopic splanchnicectomy? Reg Anesth Pain Med. 2011;36(6):531-536.
Bouwense SA, Olesen SS, Drewes AM, Frokjaer JB, van Goor H, Wilder-Smith OH. Is altered central pain processing related to disease stage in chronic pancreatitis patients with pain? An exploratory study. PLoS One. 2013;8(2):e55460.
Olesen SS, Frokjaer JB, Lelic D, Valeriani M, Drewes AM. Pain-associated adaptive cortical reorganisation in chronic pancreatitis. Pancreatology. 2010;10(6):742-751.
Olesen SS, Brock C, Krarup AL, et al. Descending inhibitory pain modulation is impaired in patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2010;8(8):724-730.
Xu GY, Winston JH, Shenoy M, Yin H, Pasricha PJ. Enhanced excitability and suppression of A-type K+ current of pancreas-specific afferent neurons in a rat model of chronic pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2006;291(3):G424-431.
Zhu Y, Mehta K, Li C, et al. Systemic administration of anti-NGF increases A-type potassium currents and decreases pancreatic nociceptor excitability in a rat model of chronic pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2012;302(1):G176-181.
Dimcevski G, Sami SA, Funch-Jensen P, et al. Pain in chronic pancreatitis: the role of reorganization in the central nervous system. Gastroenterology. 2007;132(4):1546-1556.
Cahen DL, Gouma DJ, Laramee P, et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology. 2011;141(5):1690-1695.
Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 2007;356(7):676-684.
Issa Y, Kempeneers MA, Bruno MJ, et al. Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis: The ESCAPE Randomized Clinical Trial. JAMA. 2020;323(3):237-247.
Bellin MD, Beilman GJ, Sutherland DE, et al. How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis? J Am Coll Surg. 2019;228(4):329-339.
Sutherland DE, Radosevich DM, Bellin MD, et al. Total pancreatectomy and islet autotransplantation for chronic pancreatitis. Journal of the American College of Surgeons. 2012;214(4):409-424.
Olesen SS, Phillips AE, Faghih M, et al. Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis. Gut. 2022;71(12):2518-2525.
Buscher HC, van Goor H, Sweep CG, Lenders JW, Wilder-Smith OH. Increased sympathetic activity in chronic pancreatitis patients is associated with hyperalgesia. J Pain Palliat Care Pharmacother. 2010;24(4):362-366.
Bouwense SA, Ahmed Ali U, ten Broek RP, et al. Altered central pain processing after pancreatic surgery for chronic pancreatitis. Br J Surg. 2013;100(13):1797-1804.
Buscher HC, van Goor H, Wilder-Smith OH. Effect of thoracoscopic splanchnic denervation on pain processing in chronic pancreatitis patients. Eur J Pain. 2007;11(4):437-443.
Olesen SS, Graversen C, Bouwense SA, van Goor H, Wilder-Smith OH, Drewes AM. Quantitative sensory testing predicts pregabalin efficacy in painful chronic pancreatitis. PLoS One. 2013;8(3):e57963.
Phillips AE, Faghih M, Kuhlmann L, et al. A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis. Pancreatology. 2020;20(1):25-34.
Phillips AE, Faghih M, Singh VK, et al. Rationale for and Development of the Pancreatic Quantitative Sensory Testing Consortium to Study Pain in Chronic Pancreatitis. Pancreas. 2021;50(9):1298-1304.
Faghih M, Phillips AE, Kuhlmann L, et al. Pancreatic QST Differentiates Chronic Pancreatitis Patients into Distinct Pain Phenotypes Independent of Psychiatric Comorbidities. Clin Gastroenterol Hepatol. 2022;20(1):153-161.e152.
Phillips AE, Bick BL, Faghih M, et al. Pain Sensitivity and Psychiatric Comorbidities in Chronic Pancreatitis Patients With and Without Pain: Past Experience Matters. Gastro Hep Adv. 2022;1(5):796-802.
Phillips AE, Faghih M, Singh VK, et al. Widespread Hyperalgesia by Pancreatic Quantitative Sensory Testing Is Associated With Reduced Pain Response in Chronic Pancreatitis. Pancreas. 2023;52(4):e257-e258.
Phillips AE, Afghani E, Akshintala VS, et al. Pancreatic quantitative sensory testing to predict treatment response of endoscopic therapy or surgery for painful chronic pancreatitis with pancreatic duct obstruction: study protocol for an observational clinical trial. BMJ Open. 2024;14(3):e081505.
Faghih M, Damm M, Bandhauer C, et al. Pancreatic adenocarcinoma patients with pain have abnormal central pain processing. Pancreatology. 2025;25(3):426-432.
Goltl P, Merz P, Schneider A, Ebert MP, Hirth M, Magerl W. Somatosensory profiling to differentiate distinct painful diseases of the pancreas-a quantitative sensory testing case-control study. Pain. 2025;166(10):2322-2331.
Petersen KK, Arendt-Nielsen L, Simonsen O, Wilder-Smith O, Laursen MB. Presurgical assessment of temporal summation of pain predicts the development of chronic postoperative pain 12 months after total knee replacement. Pain. 2015;156(1):55-61.
Wylde V, Palmer S, Learmonth ID, Dieppe P. The association between pre-operative pain sensitisation and chronic pain after knee replacement: an exploratory study. Osteoarthritis Cartilage. 2013;21(9):1253-1256.
Lundblad H, Kreicbergs A, Jansson KA. Prediction of persistent pain after total knee replacement for osteoarthritis. J Bone Joint Surg Br. 2008;90(2):166-171.
Keefer L, Ko CW, Ford AC. AGA Clinical Practice Update on Management of Chronic Gastrointestinal Pain in Disorders of Gut-Brain Interaction: Expert Review. Clin Gastroenterol Hepatol. 2021;19(12):2481-2488.e2481.
Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet. 2020;396(10263):1675-1688.
Ford AC, Mahadeva S, Carbone MF, Lacy BE, Talley NJ. Functional dyspepsia. Lancet. 2020;396(10263):1689-1702.
van der Veek PP, Van Rood YR, Masclee AA. Symptom severity but not psychopathology predicts visceral hypersensitivity in irritable bowel syndrome. Clin Gastroenterol Hepatol. 2008;6(3):321-328.
Posserud I, Syrous A, Lindström L, Tack J, Abrahamsson H, Simrén M. Altered rectal perception in irritable bowel syndrome is associated with symptom severity. Gastroenterology. 2007;133(4):1113-1123.
Sabate JM, Veyrac M, Mion F, et al. Relationship between rectal sensitivity, symptoms intensity and quality of life in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2008;28(4):484-490.
Wilder-Smith CH, Robert-Yap J. Abnormal endogenous pain modulation and somatic and visceral hypersensitivity in female patients with irritable bowel syndrome. World J Gastroenterol. 2007;13(27):3699-3704.
Bouin M, Meunier P, Riberdy-Poitras M, Poitras P. Pain hypersensitivity in patients with functional gastrointestinal disorders: a gastrointestinal-specific defect or a general systemic condition? Dig Dis Sci. 2001;46(11):2542-2548.
Piché M, Arsenault M, Poitras P, Rainville P, Bouin M. Widespread hypersensitivity is related to altered pain inhibition processes in irritable bowel syndrome. Pain. 2010;148(1):49-58.
Stabell N, Stubhaug A, Flægstad T, Mayer E, Naliboff BD, Nielsen CS. Widespread hyperalgesia in adolescents with symptoms of irritable bowel syndrome: results from a large population-based study. J Pain. 2014;15(9):898-906.
Rodrigues AC, Nicholas Verne G, Schmidt S, Mauderli AP. Hypersensitivity to cutaneous thermal nociceptive stimuli in irritable bowel syndrome. Pain. 2005;115(1-2):5-11.
Albusoda A, Ruffle JK, Friis KA, et al. Systematic review with meta-analysis: conditioned pain modulation in patients with the irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(8):797-806.
Marcuzzi A, Chakiath RJ, Siddall PJ, et al. Conditioned Pain Modulation (CPM) is Reduced in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of CPM and the Role of Psychological Factors. J Clin Gastroenterol. 2019;53(6):399-408.
Narendren A, Boddupalli S, Segal JP. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Frontline Gastroenterol. 2024;15(1):70-73.
Li X, Cao Y, Wong RK, Ho KY, Wilder-Smith CH. Visceral and somatic sensory function in functional dyspepsia. Neurogastroenterol Motil. 2013;25(3):246-253, e165.
Feinle-Bisset C, Azpiroz F. Dietary lipids and functional gastrointestinal disorders. Am J Gastroenterol. 2013;108(5):737-747.
Rao SS, Read NW, Davison PA, Bannister JJ, Holdsworth CD. Anorectal sensitivity and responses to rectal distention in patients with ulcerative colitis. Gastroenterology. 1987;93(6):1270-1275.
Chang L, Munakata J, Mayer EA, et al. Perceptual responses in patients with inflammatory and functional bowel disease. Gut. 2000;47(4):497-505.
Brochard C, Siproudhis L, Ropert A, Mallak A, Bretagne JF, Bouguen G. Anorectal dysfunction in patients with ulcerative colitis: impaired adaptation or enhanced perception? Neurogastroenterol Motil. 2015;27(7):1032-1037.
Mavroudis G, Strid H, Jonefjäll B, Simrén M. Visceral hypersensitivity is together with psychological distress and female gender associated with severity of IBS-like symptoms in quiescent ulcerative colitis. Neurogastroenterol Motil. 2021;33(3):e13998.
Tillisch K, Mayer EA, Labus JS. Quantitative meta-analysis identifies brain regions activated during rectal distension in irritable bowel syndrome. Gastroenterology. 2011;140(1):91-100.
Yuan YZ, Tao RJ, Xu B, et al. Functional brain imaging in irritable bowel syndrome with rectal balloon-distention by using fMRI. World J Gastroenterol. 2003;9(6):1356-1360.
Mertz H, Morgan V, Tanner G, et al. Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. Gastroenterology. 2000;118(5):842-848.
Frøkjær JB, Bouwense SA, Olesen SS, et al. Reduced cortical thickness of brain areas involved in pain processing in patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2012;10(4):434-438.e431.
Frøkjær JB, Olesen SS, Gram M, et al. Altered brain microstructure assessed by diffusion tensor imaging in patients with chronic pancreatitis. Gut. 2011;60(11):1554-1562.
Muthulingam JA, Hansen TM, Drewes AM, Olesen SS, Frøkjær JB. Disrupted functional connectivity of default mode and salience networks in chronic pancreatitis patients. Clin Neurophysiol. 2020;131(5):1021-1029.
Abber SR, Burton-Murray H. Evidence without evolution: a call for precision behavioural therapy in irritable bowel syndrome. Lancet Gastroenterol Hepatol. 2025;10(12):1055-1057.
Whitehead WE, Palsson OS. Is rectal pain sensitivity a biological marker for irritable bowel syndrome: psychological influences on pain perception. Gastroenterology. 1998;115(5):1263-1271.
Chen J, Li A, Wu W, et al. Machine learning to phenotype pain and predict response to pain interventions among young adults with irritable bowel syndrome. medRxiv. 2025.
Petersen KK, Hughes S, Vollert J. The use of quantitative sensory testing for personalized pain medicine in the age of AI. Pain. 2025;166(11S):S85-S90.
Weaver KR, Griffioen MA, Klinedinst NJ, et al. Quantitative Sensory Testing Across Chronic Pain Conditions and Use in Special Populations. Front Pain Res (Lausanne). 2021;2:779068.
Geber C, Klein T, Azad S, et al. Test-retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): a multi-centre study. Pain. 2011;152(3):548-556.
Mulak A. Testing of visceral sensitivity. J Physiol Pharmacol. 2003;54 Suppl 4:55-72.
Andresen V. Visceral sensitivity testing. Best Pract Res Clin Gastroenterol. 2009;23(3):313-324.
Li Y, Wang Y, Zuo X, et al. Visceral perception thresholds after rectal thermal and pressure stimuli in irritable bowel syndrome patients. J Gastroenterol Hepatol. 2004;19(2):187-191.
Zuo XL, Li YQ, Shi L, et al. Visceral hypersensitivity following cold water intake in subjects with irritable bowel syndrome. J Gastroenterol. 2006;41(4):311-317.
Rössel P, Arendt-Nielsen L, Niddam D, Chen AC, Drewes AM. Short latency cerebral response evoked by painful electrical stimulation applied to the human sigmoid colon and to the convergent referred somatic pain area. Exp Brain Res. 2003;151(1):115-122.
Coffin B, Bouhassira D, Sabaté JM, Barbe L, Jian R. Alteration of the spinal modulation of nociceptive processing in patients with irritable bowel syndrome. Gut. 2004;53(10):1465-1470.
Jung B, Steinbach J, Beaumont C, Mittal RK. Lack of association between esophageal acid sensitivity detected by prolonged pH monitoring and Bernstein testing. Am J Gastroenterol. 2004;99(3):410-415.
van Wanrooij SJ, Wouters MM, Van Oudenhove L, et al. Sensitivity testing in irritable bowel syndrome with rectal capsaicin stimulations: role of TRPV1 upregulation and sensitization in visceral hypersensitivity? Am J Gastroenterol. 2014;109(1):99-109.
Brock C, Nissen TD, Gravesen FH, et al. Multimodal sensory testing of the rectum and rectosigmoid: development and reproducibility of a new method. Neurogastroenterol Motil. 2008;20(8):908-918.
Drewes AM, Schipper KP, Dimcevski G, et al. Multimodal assessment of pain in the esophagus: a new experimental model. Am J Physiol Gastrointest Liver Physiol. 2002;283(1):G95-103.
Sarkar S, Woolf CJ, Hobson AR, Thompson DG, Aziz Q. Perceptual wind-up in the human oesophagus is enhanced by central sensitisation. Gut. 2006;55(7):920-925.
King CD, Wong F, Currie T, Mauderli AP, Fillingim RB, Riley JL. Deficiency in endogenous modulation of prolonged heat pain in patients with Irritable Bowel Syndrome and Temporomandibular Disorder. Pain. 2009;143(3):172-178.
Downloads
Published
Versions
- 2026-03-29 (2)
- 2026-03-28 (1)
Issue
Section
License
Copyright (c) 2026 SMART-MD Journal of Precision Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Journal information