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Sensory changes and loss of intraepidermal nerve fibers in painful unilateral nerve injury.
Clin J Pain. 2009 Oct; 25(8):683-90.CJ

Abstract

OBJECTIVES

Dysaesthesias is a common symptom in patients with neuropathic pain after peripheral nerve injury (PNI). In contrast to neuropathies with comparable symptoms there is little knowledge of the underlying mechanisms in PNI patients.

METHODS

Quantitative sensory testing according to the German Research Network on Neuropathic Pain protocol, and changes in intraepidermal nerve fiber density were assessed in 15 patients with dysaesthesias after PNI of the lower limb. According to their small-fiber function patients were assigned into 2 subgroups.

RESULTS

The sensory profiles of PNI patients were characterized predominantly by minus symptoms (significantly increased thresholds for perception of cold, warm, touch and vibration, and significantly increased thresholds for heat and mechanical pain) on the affected compared with the unaffected side. The only plus symptom reported was a significantly reduced pressure pain threshold. The sensory profile of patients with a severe loss of small-fiber function (n=7) showed a thermal and tactile hypoaesthesia and hypoalgesia; this was in contrast to patients with a moderate loss of small-fiber function, who showed a mild thermal and tactile hypoaesthesia associated with an increased mechanical pain sensitivity. Mean intraepidermal nerve fiber density was significantly decreased in the affected compared with unaffected skin [3.50 (4.00) vs. 11.10 (7.60) fibers/mm] and correlated with warm and mechanical detection thresholds (both r=-0.60).

DISCUSSION

In conclusion, even though patients presented with comparable clinical symptoms, their sensory profiles differed, supporting the concept of different underlying mechanisms leading to chronic pain in PNI patients. Skin biopsies support the validity of quantitative sensory testing.

Authors+Show Affiliations

Department of Pain Management, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, Bochum, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19920717

Citation

Schüning, Julia, et al. "Sensory Changes and Loss of Intraepidermal Nerve Fibers in Painful Unilateral Nerve Injury." The Clinical Journal of Pain, vol. 25, no. 8, 2009, pp. 683-90.
Schüning J, Scherens A, Haussleiter IS, et al. Sensory changes and loss of intraepidermal nerve fibers in painful unilateral nerve injury. Clin J Pain. 2009;25(8):683-90.
Schüning, J., Scherens, A., Haussleiter, I. S., Schwenkreis, P., Krumova, E. K., Richter, H., & Maier, C. (2009). Sensory changes and loss of intraepidermal nerve fibers in painful unilateral nerve injury. The Clinical Journal of Pain, 25(8), 683-90. https://doi.org/10.1097/AJP.0b013e3181a1260e
Schüning J, et al. Sensory Changes and Loss of Intraepidermal Nerve Fibers in Painful Unilateral Nerve Injury. Clin J Pain. 2009;25(8):683-90. PubMed PMID: 19920717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sensory changes and loss of intraepidermal nerve fibers in painful unilateral nerve injury. AU - Schüning,Julia, AU - Scherens,Andrea, AU - Haussleiter,Ida S, AU - Schwenkreis,Peter, AU - Krumova,Elena K, AU - Richter,Helmut, AU - Maier,Christoph, PY - 2009/11/19/entrez PY - 2009/11/19/pubmed PY - 2010/1/27/medline SP - 683 EP - 90 JF - The Clinical journal of pain JO - Clin J Pain VL - 25 IS - 8 N2 - OBJECTIVES: Dysaesthesias is a common symptom in patients with neuropathic pain after peripheral nerve injury (PNI). In contrast to neuropathies with comparable symptoms there is little knowledge of the underlying mechanisms in PNI patients. METHODS: Quantitative sensory testing according to the German Research Network on Neuropathic Pain protocol, and changes in intraepidermal nerve fiber density were assessed in 15 patients with dysaesthesias after PNI of the lower limb. According to their small-fiber function patients were assigned into 2 subgroups. RESULTS: The sensory profiles of PNI patients were characterized predominantly by minus symptoms (significantly increased thresholds for perception of cold, warm, touch and vibration, and significantly increased thresholds for heat and mechanical pain) on the affected compared with the unaffected side. The only plus symptom reported was a significantly reduced pressure pain threshold. The sensory profile of patients with a severe loss of small-fiber function (n=7) showed a thermal and tactile hypoaesthesia and hypoalgesia; this was in contrast to patients with a moderate loss of small-fiber function, who showed a mild thermal and tactile hypoaesthesia associated with an increased mechanical pain sensitivity. Mean intraepidermal nerve fiber density was significantly decreased in the affected compared with unaffected skin [3.50 (4.00) vs. 11.10 (7.60) fibers/mm] and correlated with warm and mechanical detection thresholds (both r=-0.60). DISCUSSION: In conclusion, even though patients presented with comparable clinical symptoms, their sensory profiles differed, supporting the concept of different underlying mechanisms leading to chronic pain in PNI patients. Skin biopsies support the validity of quantitative sensory testing. SN - 1536-5409 UR - https://www.unboundmedicine.com/medline/citation/19920717/Sensory_changes_and_loss_of_intraepidermal_nerve_fibers_in_painful_unilateral_nerve_injury_ L2 - https://doi.org/10.1097/AJP.0b013e3181a1260e DB - PRIME DP - Unbound Medicine ER -