Sensory Retraining: A Cognitive Behavioral Therapy for Altered Sensation

Abstract

Peripheral Facial NeuropathyEvery year in the US, millions of people suffer from peripheral neuropathy caused by accidental, compressive, or iatrogenic, e.g. surgically associated, injury to the peripheral nervous system (PNS). Virtually all of the peripheral nerve injuries to the face occur as a result of nerve compression, stretching, or inflammation of the trigeminal nerve. Elucidation of the mechanisms that influence the rate of peripheral nerve repair after injury is of particular importance for the development of treatments for patients who, after an iatrogenic or other traumatic injury to a peripheral nerve, experience suboptimal recovery of sensory function or the development of neuropathic pain (1,2). Sensory peripheral nerve injury can result in symptoms that range from a complete or partial loss of sensation (anesthesia or hypoesthesia); to nonpainful tingling sensations (paresthesia); to increased sensitivity to touch or pressure with or without numbness or pain (hyperesthesia or dysesthesia) and numbness. (3,4,5). The extent of sensory impairment as indicated by stimulus testing measures has been shown to be reflected in the word descriptors that patients choose to describe their symptoms of altered sensation. (6) Most trigeminal nerve injuries are associated with fracture of the mandible or maxilla. For example, the incidence of somatosensory deficits following facial injuries has been reported as 54.5% in nondisplaced fractures, 88.2% in dislocated fractures, and 100% in fractures with a direct nerve injury. (7) Indeed, following bilateral sagittal split osteotomy, the incidence of nerve injury (8,9,10) approaches 100%. Using nerve conduction recording methods, the gold standard for assessing the structural integrity of a nerve, one study of 38 The authors have nothing to disclose.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Soft tissue injury and inflammation generally resolves in the first post-operative month after surgery but the sensory sequelae of the nerve injury may persist for at least 2 years after surgery -the longest duration that most studies have followed patients after treatment (11,12,13,14,15,16,17). Greater than 60% percent of BSSO patients report persistent altered sensation six months after surgery and approximately 20% use descriptors suggestive of unpleasant sensations (dysesthesia) including pain (4,6,11). NIH Public Access Afferent Nerve Recovery and Cortical Remodeling after Nerve InjuryFollowing any degree of peripheral nerve injury, a complex of cellular and molecular signaling alterations is immediately initiated, and the qual...

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