Subclinical Sensory Abnormalities in Trigeminal Neuralgia

Trigeminal neuralgia is considered as a paroxysmal single nerve phenomenon. Abnormal sensory perception has been previously described in 15-25% of patients with clinical examination. Quantitative sensory testing (QST) was used to evaluate sensory perception in patients with idiopathic trigeminal neuralgia (ITN). Nine patients and 10 normal control subjects were evaluated in all six trigeminal branches. QST abnormalities were found in the symptomatic division and in the other two branches on the same side. Minor contralateral changes were also found. Differences consisted of cold and warm hypoaesthesia and higher cold and heat pain thresholds in patients. All differences proved statistically significant. Our findings suggest that trigeminal neuralgia is not only a paroxysmal single nerve disorder, but also that other higher structures may be involved.

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Subtle Sensory Abnormalities Detected by Quantitative Sensory Testing in Patients with Trigeminal Neuralgia

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.507 ◽

2016 ◽

Vol 7;19 (7;9) ◽

pp. 507-517

Author(s):

Joachim K. Krauss

Keyword(s):

Neuropathic Pain ◽

Trigeminal Neuralgia ◽

Clinical Examination ◽

Trigeminal Nerve ◽

Quantitative Sensory Testing ◽

University Hospital ◽

Sensory Testing ◽

Invasive Treatment ◽

Sensory Abnormalities ◽

Routine Clinical Examination

Background: Trigeminal neuralgia (TN) is characterized by paroxysmal pain attacks affecting the somatosensory distributions of the trigeminal nerve. It is thought to be associated with a neurovascular conflict most frequently, but pathomechanisms have not been fully elucidated. In general, no sensory deficit is found in routine clinical examination. There is limited data available, however, showing subtle subclinical sensory deficits upon extensive testing. Objective: We used quantitative sensory testing (QST) to detect abnormalities in sensory processing in patients with TN by comparing the affected and non-affected nerve branches with their contralateral counterparts and by comparing the results of the patients with those of controls. Study Design: Observational study. Setting: University Hospital, Departments of Neurosurgery, Institute for Cognitive and Clinical Neuroscience. Methods: QST was conducted on 48 patients with idiopathic TN and 27 controls matched for age and gender using the standardized protocol of the German Neuropathic Pain Network. Stimulations were performed bilaterally in the distribution of the trigeminal branches. The patients had no prior invasive treatment, and medications at the time of examination were noted. Results: In patients with TN deficits in warm and cold sensory detection thresholds in the affected and also the non-affected nerve branches were found. Tactile sensation thresholds were elevated in the involved nerve branches compared to the contralateral side. Limitations: More data are needed on the correlation of such findings with the length of history of TN and with changes of the morphology of the trigeminal nerve. Conclusions: QST shows subtle sensory abnormalities in patients with TN despite not being detected in routine clinical examination. Our data may provide a basis for further research on the development of TN and also on improvement after treatment. Key words: Quantitative sensory testing, trigeminal neuralgia, facial pain, neuropathic pain, microvascular decompression, cranial nerve

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RESEARCH AND EVALUATION OF REFERENCE VALUES OF TEMPERATURE QUANTITATIVE SENSORY TESTING IN KARELIA RESIDENTS

Regional Anesthesia and Acute Pain Management ◽

10.18821/1993-6508-2017-11-4-247-256 ◽

2017 ◽

Vol 11 (4) ◽

pp. 247-256

Author(s):

A. P Spasova ◽

A. M Dorozhenko ◽

G. P Tikhova ◽

O. Yu Barysheva

Keyword(s):

Reference Values ◽

Temperature Sensor ◽

Quantitative Sensory Testing ◽

Normal Values ◽

Pain Syndrome ◽

Heat Pain ◽

Sensory Testing ◽

Testing Methods ◽

Pain Thresholds ◽

Pain Syndromes

Relevance: Quantitative sensory testing is a promising method for evaluating mechanisms that promote the development of pain syndrome, the use of which can improve the diagnosis and effectiveness of pain management. Objective: to study and evaluate the reference values of temperature sensor testing. Methods: reference values of thresholds for cold and warm thresholds, cold and heat pain thresholds in sensory points L4, L5, S1, C5, C6, C7 and C8 in 34 healthy volunteers aged 18 to 40 years were determined. Results: The range of normal values of temperature values of QST for residents of Karelia is determined. Conclusion: The reference values of temperature quantitative sensory testing differ from those obtained for residents of other countries. These results must be taken into account in determining the normal and pathology in patients with pain syndromes.

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Pain sensitivity in young adults with juvenile idiopathic arthritis: a quantitative sensory testing study

Arthritis Research & Therapy ◽

10.1186/s13075-020-02345-2 ◽

2020 ◽

Vol 22 (1) ◽

Author(s):

Ellen Dalen Arnstad ◽

Johanne Marie Iversen ◽

Martin Uglem ◽

Mia Glerup ◽

Pål Richard Romundstad ◽

...

Keyword(s):

Young Adults ◽

Quantitative Sensory Testing ◽

Pain Sensitivity ◽

Pain Perception ◽

Disease Duration ◽

Heat Pain ◽

Sensory Testing ◽

Pain Thresholds ◽

First Time ◽

Age And Sex

Abstract Background To study for the first-time, pain perception, pain sensitivity, and self-reported pain in young adults with long disease duration of juvenile idiopathic arthritis (JIA) compared with controls. Methods Children from Central Norway diagnosed with JIA between 1997 and 2004 were included consecutively in a population-based prospective study. Children with onset 1997–2000 were part of the Nordic JIA cohort. Controls were age- and sex-matched. In 2015–2017, study visits with investigator-blinded quantitative sensory testing (QST) comprising cold and warm detection thresholds (CDT/WDT), cold and heat pain thresholds (CPT/HPT), pressure pain threshold (PPT), and a suprathreshold heat pain test were performed. We constructed separate multilevel models for each variable of detection and pain thresholds with interaction between groups and site adjusted for the effect of age and sex. Results Among 96 young adults with JIA, 71% were female, median age was 22.7 years, disease duration was 16.1 years, and 47% had oligoarticular disease. Among 109 controls, 71% were female, and median age was 23.5 years. Participants with JIA had lower pressure pain thresholds (PPTs) (95% CI) compared to controls, upper limb 888 (846,930) versus 1029 (999,1059) kPa and lower limb 702 (670,734) versus 760 (726,794) kPa. Participants with inactive disease had the lowest PPTs and cold pain thresholds (CPTs), compared to those in remission off medication and those with active disease. Minor differences were found regarding CDT/WDT and CPT/HPT in JIA compared to controls. The median (IQR) temperature needed to evoke pain = 6 on a 0–10 numeric rating scale (NRS) in the suprathreshold heat pain tests were lower in JIA than in controls (46 °C (45–47 °C) versus 47 °C (46–48 °C)). We found no associations between self-reported pain and pain thresholds. Conclusions Our results indicate for the first time that young adults with long disease duration of JIA may have altered pain perception and sensitivity compared to controls. A clinical implication may be the importance of early treatment to quickly achieve pain-free remission and avoid long-term pain sensitization.

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Patients with Minimal Hepatic Encephalopathy Show Altered Thermal Sensitivity and Autonomic Function

Journal of Clinical Medicine ◽

10.3390/jcm10020239 ◽

2021 ◽

Vol 10 (2) ◽

pp. 239

Author(s):

Dalia Rega ◽

Mika Aiko ◽

Nicolás Peñaranda ◽

Amparo Urios ◽

Juan-José Gallego ◽

...

Keyword(s):

Nervous System ◽

Hepatic Encephalopathy ◽

Quantitative Sensory Testing ◽

Autonomic Function ◽

Thermal Sensitivity ◽

Somatosensory System ◽

Minimal Hepatic Encephalopathy ◽

Heat Pain ◽

Sensory Testing ◽

Cirrhotic Patients

Cirrhotic patients may experience alterations in the peripheral nervous system and in somatosensory perception. Impairment of the somatosensory system could contribute to cognitive and motor alterations characteristic of minimal hepatic encephalopathy (MHE), which affects up to 40% of cirrhotic patients. We assessed the relationship between MHE and alterations in thermal, vibration, and/or heat pain sensitivity in 58 cirrhotic patients (38 without and 20 with MHE according to Psychometric Hepatic Encephalopathy Score) and 39 controls. All participants underwent attention and coordination tests, a nerve conduction study, autonomic function testing, and evaluation of sensory thresholds (vibration, cooling, and heat pain detection) by electromyography and quantitative sensory testing. The detection thresholds for cold and heat pain on the foot were higher in patients with, than those without MHE. This hyposensitivity was correlated with attention deficits. Reaction times in the foot were longer in patients with, than without MHE. Patients with normal sural nerve amplitude showed altered thermal sensitivity and autonomic function, with stronger alterations in patients with, than in those without MHE. MHE patients show a general decrease in cognitive and sensory abilities. Small fibers of the autonomic nervous system and thermal sensitivity are altered early on in MHE, before large sensory fibers. Quantitative sensory testing could be used as a marker of MHE.

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Validation of a Brazilian quantitative sensory testing (QST) device for the diagnosis of small fiber neuropathies

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000700019 ◽

2011 ◽

Vol 69 (6) ◽

pp. 943-948 ◽

Cited By ~ 25

Author(s):

Pedro Schestatsky ◽

Luciana Cadore Stefani ◽

Paulo Roberto Sanches ◽

Danton Pereira da Silva Júnior ◽

Iraci Lucena Silva Torres ◽

...

Keyword(s):

Quantitative Sensory Testing ◽

Stimulus Change ◽

Heat Pain ◽

Thermal Perception ◽

Sensory Testing ◽

Brazilian Sample ◽

Small Fiber ◽

Normal Individuals ◽

Nociceptive Pathway

Quantitative sensory testing (QST) is defined as the determination of thresholds for sensory perception under controlled stimulus. Our aim was to validate a new QST device for Brazilian sample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm² thermode with a 1°C/s stimulus change rate were applied. Thresholds of three consecutive stimuli were averaged in two different sessions separated by at least two weeks. Additionally long thermal heat pain stimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermal perception thresholds in normal individuals and plausible abnormal thresholds in patients. We conclude that our QST device is reliable when analyzing the nociceptive pathway in controls and patients.

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