Concept of acute neuropathic pain. The role of nervi nervorum in the distinction between acute nociceptive and neuropathic pain

Teixeira, Manoel Jacobsen; Almeida, Daniel Benzecry de; Yeng, Lin Tchia

doi:10.5935/1806-0013.20160038

Cited by 10 publications

(7 citation statements)

References 73 publications

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“…The fibers of these tiny nerves belong to group A Delta [ 31 , 32 ], which is most sensitive to pressure [ 33 ]. In mild and moderate degrees of FN trunk damage (neuropraxia), the injury may result in some form of localized damage to the myelin sheath.…”

Section: Discussionmentioning

confidence: 99%

Bell’s Palsy—Retroauricular Pain Threshold

et al. 2021

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Background and objectives: Non-motor symptoms in the form of increased sensitivity are often associated with the onset of idiopathic Bell’s palsy (IBP). The aims were to determine whether the pain threshold in the retroauricular regions (RAR) in IBP patients and the time of its occurrence is related to IBP severity. Materials and Methods: The study was conducted among 220 respondents (142 IBP patients, 78 healthy subjects (HS)). The degree of IBP was graded using the House–Brackmann and Sunnybrook Grading Scales (II—mild dysfunction, VI—total paralysis), whereas the pain thresholds were measured using the digital pressure algometer. Results: We found no difference in the degree of the pain threshold between the right and left RAR in the HS group. IBP patients belonging to groups II, III, IV, and V had lower pain thresholds in both RARs than HS and IBP patients belonging to group VI. There was no difference in the degree of pain threshold in RAR between the affected and unaffected side in IBP patients. The incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups II and III of IBP patients is noticeably lower and the incidence of retroauricular pain that occurred only after the onset of paralysis is more frequent. Also, we found that the incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups V and VI of IBP patients was more frequent. Conclusions: The degree of pain threshold lowering in RAR (bilaterally) is inversely related to the severity of IBP. We suggest that the occurrence of retroauricular pain before the onset of facial weakness is associated with higher severity of IBP while the occurrence after the onset is associated with lower severity of IBP.

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Section: Discussionmentioning

confidence: 99%

Bell’s Palsy—Retroauricular Pain Threshold

et al. 2021

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“…It acts as nociceptors. They signal pain from direct stimulation [36,37]. The spinal accessory neuropathy could be a predisposing factor for nociceptive hypersensitivity of MTrPs and induction of pain [38].…”

Section: Discussionmentioning

confidence: 99%

Spinal accessory neuropathy in patients with chronic trapezius myofascial pain syndrome

Sharnoby¹,

Sultan

Saba

2020

Egypt Rheumatol Rehabil

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Background Myofascial pain syndrome is a common musculoskeletal problem affecting the trapezius muscle. The aim was to assess the presence of spinal accessory neuropathy in patients with unilateral chronic trapezius myofascial pain syndrome. Results The study included 25 patients with unilateral chronic trapezius myofascial pain syndrome and 20 apparently healthy volunteers as the control group. There was a significantly delayed spinal accessory nerve latency on the symptomatic side in comparison to either asymptomatic side (P = 0.014) and control group (P = 0.001). Compound muscle action potential amplitude did not significantly differ between the symptomatic side versus the asymptomatic side and control group. Delayed spinal accessory nerve latency was present in seven patients (28%) and reduced compound muscle action potential amplitude in one of them (4%). The needle electromyography of the upper trapezius muscle revealed neuropathic motor units and incomplete interference pattern in the patient who showed reduced compound muscle action potential amplitude. Abnormal rest potentials were absent in all patients. Individually, seven patients (28%) had electrophysiological evidence of spinal accessory neuropathy, but only one (4%) of them had clinical evidence of spinal accessory neuropathy. Patients with abnormal electrophysiological findings had longer duration of complaint and more severe pain. Conclusions Spinal accessory neuropathy is common among patients with chronic trapezius myofascial pain syndrome. It could contribute to increased pain severity of myofascial pain syndrome. Electrodiagnosis is a good modality for identifying subclinical spinal accessory neuropathy.

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“…Notably, nerve damage produces stronger sensitizing input than peripheral non-neural lesions: skin hypersensitivity lasts up to 24 h after capsaicin injection ( 69 ), ten days after incision ( 70 ), and over two months after nerve injury ( 65 ). Sensitizing effects of nerve injury obviously also apply to the nociceptive nervi nervorum , activity of which may account for peripheral nerve trunk pain ( 71 – 74 ). Clinically, sensitization-induced pain hypersensitivity can be measured as reduced pressure pain threshold (PPT) ( 75 ).…”

Section: Pre-hypothetical Reasoning: Ectopic Nociceptive Sensitizatio...mentioning

confidence: 99%

Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion

Macionis¹

2023

Front. Pain Res.

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It has been unexplained why chronic pain does not invariably accompany chronic pain-prone disorders. This question-driven, hypothesis-based article suggests that the reason may be varying occurrence of concomitant peripheral compressive proximal neural lesion (cPNL), e.g., radiculopathy and entrapment plexopathies. Transition of acute to chronic pain may involve development or aggravation of cPNL. Nociceptive hypersensitivity induced and/or maintained by cPNL may be responsible for all types of general chronic pain as well as for pain in isolated tissue conditions that are usually painless, e.g., neuroma, scar, and Dupuytren's fibromatosis. Compressive PNL induces focal neuroinflammation, which can maintain dorsal root ganglion neuron (DRGn) hyperexcitability (i.e., peripheral sensitization) and thus fuel central sensitization (i.e., hyperexcitability of central nociceptive pathways) and a vicious cycle of chronic pain. DRGn hyperexcitability and cPNL may reciprocally maintain each other, because cPNL can result from reflexive myospasm-induced myofascial tension, muscle weakness, and consequent muscle imbalance- and/or pain-provoked compensatory overuse. Because of pain and motor fiber damage, cPNL can worsen the causative musculoskeletal dysfunction, which further accounts for the reciprocity between the latter two factors. Sensitization increases nerve vulnerability and thus catalyzes this cycle. Because of these mechanisms and relatively greater number of neurons involved, cPNL is more likely to maintain DRGn hyperexcitability in comparison to distal neural and non-neural lesions. Compressive PNL is associated with restricted neural mobility. Intermittent (dynamic) nature of cPNL may be essential in chronic pain, because healed (i.e., fibrotic) lesions are physiologically silent and, consequently, cannot provide nociceptive input. Not all patients may be equally susceptible to develop cPNL, because occurrence of cPNL may vary as vary patients' predisposition to musculoskeletal impairment. Sensitization is accompanied by pressure pain threshold decrease and consequent mechanical allodynia and hyperalgesia, which can cause unusual local pain via natural pressure exerted by space occupying lesions or by their examination. Worsening of local pain is similarly explainable. Neuroma pain may be due to cPNL-induced axonal mechanical sensitivity and hypersensitivity of the nociceptive nervi nervorum of the nerve trunk and its stump. Intermittence and symptomatic complexity of cPNL may be the cause of frequent misdiagnosis of chronic pain.

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Concept of acute neuropathic pain. The role of nervi nervorum in the distinction between acute nociceptive and neuropathic pain

Cited by 10 publications

References 73 publications

Bell’s Palsy—Retroauricular Pain Threshold

Bell’s Palsy—Retroauricular Pain Threshold

Spinal accessory neuropathy in patients with chronic trapezius myofascial pain syndrome

Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion

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