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Functional Characterization of At-Level Hypersensitivity in Patients With Spinal Cord Injury
- Source :
- The Journal of Pain. 18:66-78
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- At-level and above-level hypersensitivity was assessed in patients with chronic complete thoracic spinal cord injury (SCI). Patients were classified using somatosensory mapping (brush, cold, pinprick) and assigned into 2 groups (ie, patients with at-level hypersensitivity [SCIHs, n = 8] and without at-level hypersensitivity [SCINHs, n = 7]). Gender and age-matched healthy subjects served as controls. Quantitative sensory testing (QST), electrically- and histamine-induced pain and itch, laser Doppler imaging, and laser-evoked potentials (LEP) were recorded at-level and above-level in SCI-patients. Six of 8 SCIHs, but 0 of 7 SCINHs patients suffered from neuropathic below-level pain. Clinical sensory mapping revealed spreading of hypersensitivity to more cranial areas (above-level) in 3 SCIHs. Cold pain threshold measures confirmed clinical hypersensitivity at-level in SCIHs. At-level and above-level hypersensitivity to electrical stimulation did not differ significantly between SCIHs and SCINHs. Mechanical allodynia, cold, and pin-prick hypersensitivity did not relate to impaired sensory function (QST), axon reflex flare, or LEPs. Clinically assessed at-level hypersensitivity was linked to below-level neuropathic pain, suggesting neuronal hyperexcitability contributes to the development of neuropathic pain. However, electrically evoked pain was not significantly different between SCI patients. Thus, SCI-induced enhanced excitability of nociceptive processing does not necessarily lead to neuropathic pain. QST and LEP revealed no crucial role of deafferentation for hypersensitivity development after SCI. Perspective At-level hypersensitivity after complete thoracic SCI is associated with neuropathic below-level pain if evoked by clinical sensory stimuli. QST, LEP, and electrically-induced axon reflex flare sizes did not indicate somatosensory deafferentation in SCIHs.
- Subjects :
- Adult
Male
Pain Threshold
0301 basic medicine
Time Factors
Laser-Evoked Potentials
Neural Conduction
Stimulation
Sensory system
Somatosensory system
Histamine Agonists
Young Adult
03 medical and health sciences
0302 clinical medicine
Evoked Potentials, Somatosensory
Hypersensitivity
Laser-Doppler Flowmetry
medicine
Humans
In patient
Spinal cord injury
Spinal Cord Injuries
Pain Measurement
Neurologic Examination
Mood Disorders
business.industry
Quantitative sensory testing
Electroencephalography
Pain Perception
Middle Aged
medicine.disease
030104 developmental biology
Anesthesiology and Pain Medicine
Neurology
Case-Control Studies
Anesthesia
Neuropathic pain
Transcutaneous Electric Nerve Stimulation
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
Histamine
Subjects
Details
- ISSN :
- 15265900
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- The Journal of Pain
- Accession number :
- edsair.doi.dedup.....bf335a4cab55267493b3c7a6d41fcc96