Reflections of the sensory findings in the central nervous system in patients with neuropathic pain

Tanıgör, Göksel; Hepgüler, Simin; Köken, İdris; Çallı, Mehmet Cem; Uyar, Meltem

doi:10.1007/s00221-022-06315-9

Cited by 4 publications

(9 citation statements)

References 48 publications

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“…In the current study, DMA was observed in 10 participants (50%) with HS. Paradoxical heat, a phenomenon in which cooling the skin causes paradoxical sensations of heat, can be induced experimentally by blocking the transmission of innocuous cool fibers and in neuropathic pain presumably by the destruction of these fibers . True paradoxical heat was only observed in 1 participant, but 2 others reported paradoxical thermal sensations during thermal testing, suggestive of potential peripheral nerve damage in HS lesions.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Sensory Testing to Characterize Sensory Changes in Hidradenitis Suppurativa Skin Lesions

Alsouhibani,

Speck,

Cole

et al. 2023

JAMA Dermatol

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ImportancePain is the most impactful symptom in patients with hidradenitis suppurativa (HS). Characterization of sensory profiles may improve understanding of pain mechanisms in HS and facilitate identification of effective pain management strategies.ObjectiveTo characterize somatosensory profiles in patients with HS at clinically affected and nonaffected sites compared with pain-free reference data.Design, Setting, and ParticipantsThis cross-sectional study was conducted at the Emory University Dermatology Clinic. It was hypothesized (1) that patients with HS would demonstrate hypersensitivity to pain in HS lesions and (2) that some patients would have sensory profiles consistent with complex pain mechanisms. Therefore, adults with dermatologist-diagnosed HS and at least 1 painful HS lesion at the time of testing were enrolled between September 10, 2020, and March 21, 2022. Patients with other diagnoses contributing to pain or neuropathy were excluded. Data analysis was conducted between March and April 2022.ExposureQuantitative sensory testing was performed on HS lesions and control skin according to a standardized protocol.Main Outcomes and MeasuresQuantitative sensory testing outcomes included innocuous thermal and mechanical sensitivity (cold, warmth, and light touch detection thresholds), noxious thermal and mechanical sensitivity (cold, heat, pinprick, and deep pressure pain thresholds and suprathreshold pinprick sensitivity), temporal summation of pinprick, paradoxical thermal sensations, and dynamic mechanical allodynia (pain upon light stroking of the skin). Sensitivity in HS lesions was compared with sensitivity in a control location (the hand) and in pain-free controls using t tests.ResultsThis study included 20 participants with a median age of 35.5 (IQR, 30.0-46.5) years, the majority of whom were women (15 [75%]). In terms of race and ethnicity, 2 participants (10%) self-identified as Asian, 11 (55%) as Black, 6 (30%) as White, and 1 (5%) as more than 1 race or ethnicity. Compared with site-specific reference values from healthy, pain-free control participants, HS lesions were insensitive to innocuous cold and warmth, noxious heat, and light touch (t = −5.69, −10.20, −3.84, and 4.46, respectively; all P &lt; .001). In contrast, HS lesions also demonstrated significant hypersensitivity to deep pressure pain (t = 8.36; P &lt; .001) and cutaneous pinprick (t = 2.07; P = .046). Hypersensitivity to deep pressure pain was also observed in the control site (t = 5.85; P &lt; .001). A subset of patients with HS displayed changes in pain processing that are often seen in neuropathic and nociplastic pain conditions, including hypersensitivity to repetitive pinprick (5 [26%]), paradoxical thermal sensations (3 [15%]), and pain upon light stroking of the skin (10 [50%]).Conclusions and RelevanceThe findings of this cross-sectional study suggest that HS involves local changes in the skin or its free nerve endings, possibly leading to peripheral neuropathy and alterations in the transduction of innocuous and noxious thermal and mechanical stimuli. For some patients, central nervous system changes in somatosensory processing may also occur, but confirmatory evidence is needed. Better understanding of neuropathic and nociplastic mechanisms in HS pain could lead to individually tailored treatments.

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Section: Discussionmentioning

confidence: 99%

Quantitative Sensory Testing to Characterize Sensory Changes in Hidradenitis Suppurativa Skin Lesions

Alsouhibani,

Speck,

Cole

et al. 2023

JAMA Dermatol

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“…Nevertheless, the system used in our study has been used in many studies for many years and has a strong background. [12,13] For this reason, it constitutes a suitable method for showing basic sensory differences.…”

Section: Discussionmentioning

confidence: 99%

“…Both upper extremities of the patients and healthy volunteers were tested, and the results were recorded. [12] Vibratory testing [12] The middle finger was chosen as the site for the test and was put on a lump of putty, which was a part of the system (CASE IV, WR Medical Electronics Co., Maplewood, MN 55109, USA). The stimulator was placed on the area between the distal interphalangeal joint and the fingernail.…”

Section: Pain Detect Questionnaire (Pdq)mentioning

confidence: 99%

“…Thermal testing [12] The investigators made sure that the participants' hands were dry and drying them before the test with a towel when necessary. The thermal stimulator (3×3 cm) was placed on the dorsal side of the hand and secured firmly with velcro straps, ensuring that the hand and the stimulator were in full contact, while being comfortable enough for the participants.…”

Section: Pain Detect Questionnaire (Pdq)mentioning

confidence: 99%

“…Case IV system has many algorithms to test the sensory thresholds, and the "4-2-1" algorithm among them was used in this study. [12] In this algorithm, the investigator first tests and determines the estimated threshold. The patient is given 20 stimuli at each measurement according to this estimated threshold.…”

Section: Pain Detect Questionnaire (Pdq)mentioning

confidence: 99%

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Assessment of Quantitative Sensory Test Findings In Cervical Radicular Pain And Their Relationship with the Symptoms

Tanıgör

Hepgüler

Köken

et al. 2022

Agri

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This study aims to define and compare sensory phenotypes in cervical radiculopathy patients exhibiting neuropathic pain (NP) components with healthy volunteers using clinical examination and quantitative sensory test (QST) findings. Another aim of the study is to show whether symptomatic components of the pain detect questionnaire (PDQ) are correlated with the QST findings, which may help clinicians indicate patients with sensory abnormalities without the use of specialized tests. Methods: Fifty-seven participants were included in the study, including patients with NP (n=20) and healthy volunteers (n=37). After obtaining the sociodemographic and clinical data of the participants, the PDQ was performed in patients with pain followed by QST analysis in all participants. Results: Analyses between painful and non-painful extremities yielded no differences in all groups for QST (p>0.05). Sensory thresholds were found to be higher in the NP group compared to healthy volunteers, and the pain threshold test was found to be lower (p<0.05) in the intergroup analyses. The changes described were found in both painful and non-painful limbs. Pain with slight pressure was found to be correlated with the lower heat pain threshold values (R=−0.602, p=0.005). Conclusion:Patients with NP were found to have lower thresholds for pain and higher sensory thresholds when compared to healthy volunteers. Moreover, pain with pressure component in PDQ was found to be associated with hyperalgesia in QST.

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Electroencephalography-based biological and functional characteristics of spinal cord injury patients with neuropathic pain and numbness

Wang,

Zhang,

Xin

et al. 2024

Front. Neurosci.

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ObjectivesTo identify potential treatment targets for spinal cord injury (SCI)-related neuropathic pain (NP) by analysing the differences in electroencephalogram (EEG) and brain network connections among SCI patients with NP or numbness.Participants and methodsThe EEG signals during rest, as well as left- and right-hand and feet motor imagination (MI), were recorded. The power spectral density (PSD) of the θ (4–8 Hz), α (8–12 Hz), and β (13–30 Hz) bands was calculated by applying Continuous Wavelet Transform (CWT) and Modified S-transform (MST) to the data. We used 21 electrodes as network nodes and performed statistical measurements of the phase synchronisation between two brain regions using a phase-locking value, which captures nonlinear phase synchronisation.ResultsThe specificity of the MST algorithm was higher than that of the CWT. Widespread non-lateralised event-related synchronization was observed in both groups during the left- and right-hand MI. The PWP (patients with pain) group had lower θ and α bands PSD values in multiple channels of regions including the frontal, premotor, motor, and temporal regions compared with the PWN (patients with numbness) group (all p < 0.05), but higher β band PSD values in multiple channels of regions including the frontal, premotor, motor, and parietal region compared with the PWN group (all p < 0.05). During left-hand and feet MI, in the lower frequency bands (θ and α bands), the brain network connections of the PWP group were significantly weaker than the PWN group except for the frontal region. Conversely, in the higher frequency bands (β band), the brain network connections of the PWP group were significantly stronger in all regions than the PWN group.ConclusionThe differences in the power of EEG and network connectivity in the frontal, premotor, motor, and temporal regions are potential biological and functional characteristics that can be used to distinguish NP from numbness. The differences in brain network connections between the two groups suggest that the distinct mechanisms for pain and numbness.

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Reflections of the sensory findings in the central nervous system in patients with neuropathic pain

Cited by 4 publications

References 48 publications

Quantitative Sensory Testing to Characterize Sensory Changes in Hidradenitis Suppurativa Skin Lesions

Quantitative Sensory Testing to Characterize Sensory Changes in Hidradenitis Suppurativa Skin Lesions

Assessment of Quantitative Sensory Test Findings In Cervical Radicular Pain And Their Relationship with the Symptoms

Electroencephalography-based biological and functional characteristics of spinal cord injury patients with neuropathic pain and numbness

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