Thermal Pain in Complex Regional Pain
Syndrome Type I

Background: Quantitative sensory testing (QST), with thermal threshold determinations, is a routine part of the comprehensive clinical workup of patients suffering from chronic pain, especially those with Complex Regional Pain Syndrome seen at our outpatient pain clinic. This is done to quantitatively assess each patient’s small fiber and sensory function in a controlled manner. Most patients have normal sensory detection thresholds, but there are large differences in thermal pain thresholds. Some patients display no thermal hyperalgesia, while other patients display severe thermal hyperalgesia when tested in all 4 limbs. Objectives: To ascertain the prevalence of thermal hyperalgesia in patients with complex regional pain syndrome type 1 (CRPS-I). Study Design: This was a retrospective review of the results of QST performed on 105 patients as part of their clinical workup. Setting: The outpatient clinic of the Department of Neurology at Drexel University College of Medicine. Methods: All patients had a diagnosis of CRPS-I. Thermal quantitative sensory testing, including cool detection, warm detection, cold pain, and heat pain, was performed on 8 distal sites on each patient as part of a comprehensive clinical examination. Results: With regards to thermal hyperalgesia, patients with CPRS-I appear to fall into distinct groups. One subgroup displays evidence of generalized cold and heat hyperalgesia, one subgroup displays evidence of generalized cold hyperalgesia only, one displays evidence of heat hyperalgesia only, and one subgroup does not display evidence of cold or heat hyperalgesia. Limitations: This study is based on retrospective information on a relatively small (105 patient records) number of patients. Since only patients with CRPS-I were included, the results are only applicable to this group. Conclusions: Thermal QST provides useful information about the sensory phenotype of individual patients. Subgrouping based on thermal hyperalgesia may be useful for future studies regarding prognosis, treatment selection, and efficacy. Key words: Complex regional pain syndrome, CRPS, quantitative sensory testing, QST, cold pain, heat pain, thermal hyperalgesia

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Quantitative Sensory Testing to Assessment Objective Changes by Spinal Cord Stimulation In-Patient with Complex Regional Pain Syndrome

10.31038/jnnc.2021413 ◽

2021 ◽

Vol 4 (1) ◽

Keyword(s):

Spinal Cord ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Quantitative Sensory Testing ◽

Pain Syndrome ◽

Sensory Testing

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Effect of 1.5% Topical Diclofenac on Clinical Neuropathic Pain

Anesthesiology ◽

10.1097/aln.0000000000000693 ◽

2015 ◽

Vol 123 (1) ◽

pp. 191-198 ◽

Cited By ~ 14

Author(s):

Shihab U. Ahmed ◽

Yi Zhang ◽

Lucy Chen ◽

Abigail Cohen ◽

Kristin St. Hillary ◽

...

Keyword(s):

Neuropathic Pain ◽

Functional Status ◽

Pain Score ◽

Complex Regional Pain Syndrome ◽

Postherpetic Neuralgia ◽

Quantitative Sensory Testing ◽

Pain Syndrome ◽

Sensory Testing ◽

Constant Pain ◽

Topical Diclofenac

Abstract Background: Neuropathic pain is a condition resulting from injury to the peripheral and/or central nervous system. Despite extensive research over the last several decades, neuropathic pain remains difficult to manage. Methods: The authors conducted a randomized, placebo-controlled, double-blinded, and crossover clinical trial to examine the effect of 1.5% topical diclofenac (TD) on neuropathic pain. The authors hypothesized that 1.5% TD would reduce the visual pain score and improve both quantitative sensory testing and functional status in subjects with neuropathic pain. The authors recruited subjects with postherpetic neuralgia and complex regional pain syndrome. The primary outcome was subject’s visual pain score. Results: Twenty-eight subjects completed the study (12 male and 16 female) with the mean age of 48.8 yr. After 2 weeks of topical application, subjects in 1.5% TD group showed lower overall visual pain score compared with placebo group (4.9 [1.9] vs. 5.6 [2.1], difference: 0.8; 95% CI, 0.1 to 1.3; P = 0.04) as well as decreased burning pain (2.9 [2.6] vs. 4.3 [2.8], difference, 1.4; 95% CI, 0.2 to 2.6; P = 0.01). There were no statistical differences in constant pain, shooting pain, or hypersensitivity over the painful area between the groups. This self-reported improvement of pain was corroborated by the decreased pain summation detected by quantitative sensory testing. There were no statistically significant changes in functional status in these subjects. There were no complications in both groups. Conclusion: The findings indicate that 1.5% TD may serve as an effective treatment option for patients with neuropathic pain from postherpetic neuralgia and complex regional pain syndrome.

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Sensory Function and Psychological Factors in Children With Complex Regional Pain Syndrome Type 1

Journal of Child Neurology ◽

10.1177/08830738211007685 ◽

2021 ◽

pp. 088307382110076

Author(s):

Emma E. Truffyn ◽

Massieh Moayedi ◽

Stephen C. Brown ◽

Danielle Ruskin ◽

Emma G. Duerden

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Assessment System ◽

Sensory Function ◽

Self Report ◽

Healthy Children ◽

Syndrome Type ◽

Cold Pain ◽

Pain Site

Objective: To assess thermal-sensory thresholds and psychosocial factors in children with Complex Regional Pain Syndrome Type 1 (CRPS-I) compared to healthy children. Methods: We conducted quantitative sensory testing on 34 children with CRPS-I and 56 pain-free children. Warm, cool, heat, and cold stimuli were applied to the forearm. Children with CRPS-I had the protocol administered to the pain site and the contralateral-pain site. Participants completed the self-report Behavior Assessment System for Children. Results: Longer pain durations (>5.1 months) were associated with decreased sensitivity to cold pain on the pain site ( P = .04). Higher pain-intensity ratings were associated with elevated anxiety scores ( P = .03). Anxiety and social stress were associated with warmth sensitivity (both P < .05) on the contralateral-pain site. Conclusions: Pain duration is an important factor in assessing pediatric CRPS-I. Hyposensitivity in the affected limb may emerge due to degeneration of nociceptive nerves. Anxiety may contribute to thermal-sensory perception in childhood CRPS-I.

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Skin Biopsy in Complex Regional Pain Syndrome: Case Series and Literature Review

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/255 ◽

2012 ◽

Vol 3;15 (3;5) ◽

pp. 255-266 ◽

Cited By ~ 1

Author(s):

Robert J. Schwartzman

Keyword(s):

Skin Biopsy ◽

Complex Regional Pain Syndrome ◽

Nerve Fiber ◽

Quantitative Sensory Testing ◽

Pain Syndrome ◽

Sensory Testing ◽

Fiber Density ◽

Epidermal Nerve Fiber Density ◽

Nerve Fiber Density ◽

Epidermal Nerve Fiber

Background: Accumulating experimental and clinical evidence supports the hypothesis that complex regional pain syndrome type I (CRPS-I) may be a small fiber neuropathy. Objectives: To evaluate the use of commercially available standard biopsy methods to detect intradermal axon pathology in CRPS-I, and to ascertain if these structural changes can explain quantitative sensory testing (QST) findings in CRPS-I. Study Design: Retrospective review of charts and laboratory data. Setting: Outpatient clinic Methods: Skin biopsies from 43 patients with CRPS-I were stained with PGP 9.5, and epidermal nerve fiber density, sweat gland nerve fiber density and morphological abnormalities were evaluated. Thirty-five patients had quantitative sensory testing. Results: Alterations in skin innervation were seen in approximately 20% of CRPS-I patients with commercial processing. There were no patient characteristics, including duration of disease, that predicted a decreased epidermal nerve fiber density (ENFD). There was no consistent relationship between QST changes and ENFD measured by standard commercial skin biopsy evaluation procedures. Limitations: Commercial processing of tissue does not utilize stereologic quantitative analysis of nerve fiber density. Biopsy material is utilized from a proximal and distal source only, and differences in denervation of a partial nerve territory may be missed. The functional attributes of small fibers cannot be assessed. Conclusions: The negative results indicate that CRPS-I may be associated with changes in the ultramicroscopic small fiber structure that cannot be visualized with commercially available techniques. Alternatively, functional rather than structural alterations of small fibers or pathological changes at a more proximal site such as the spinal cord or brain may be responsible for the syndrome. Key words: Complex Regional Pain Syndrome, CRPS-1, CRPS, skin biopsy, epidermal nerve fiber density, sweat gland nerve fiber density, quantitative sensory testing.

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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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Quantitative sensory testing, neurophysiological and psychological examination in patients with complex regional pain syndrome and hemisensory deficits

Pain ◽

10.1016/s0304-3959(01)00332-3 ◽

2001 ◽

Vol 93 (3) ◽

pp. 279-293 ◽

Cited By ~ 144

Author(s):

Oliver Rommel ◽

Jean-Pierre Malin ◽

Michael Zenz ◽

Wilfrid Jänig

Keyword(s):

Complex Regional Pain Syndrome ◽

Quantitative Sensory Testing ◽

Pain Syndrome ◽

Sensory Testing ◽

Psychological Examination

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Episodic and chronic migraineurs are hypersensitive to thermal stimuli between migraine attacks

Cephalalgia ◽

10.1177/0333102410365108 ◽

2010 ◽

Vol 31 (1) ◽

pp. 6-12 ◽

Cited By ~ 73

Author(s):

Todd J Schwedt ◽

Melissa J Krauss ◽

Karen Frey ◽

Robert W Gereau

Keyword(s):

Quantitative Sensory Testing ◽

Pain Tolerance ◽

Sensory Testing ◽

Cold Pain ◽

Pain Thresholds ◽

Thermal Pain ◽

Mechanical Pain Thresholds ◽

Thermal Stimuli ◽

Episodic Migraineurs ◽

Chronic Migraineurs

Objective: To determine if migraineurs have evidence of interictal cutaneous sensitisation. Subjects and methods: Thermal and mechanical pain thresholds in 20 episodic migraineurs, 20 chronic migraineurs, and 20 non-migraine control subjects were compared. Quantitative sensory testing was conducted when subjects had been migraine-free for at least 48 h. Heat, cold and mechanical pain thresholds, and heat and cold pain tolerance thresholds were measured. Results: Thermal pain thresholds and thermal pain tolerance thresholds differed significantly by headache group ( P = 0.001). During the interictal period, episodic and chronic migraineurs were more sensitive to thermal stimulation than non-migraine controls. Conclusions: Interictal sensitisation may predispose the migraineur to development of headaches, may be a marker of migraine activity, and a target for treatment.

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Challenges in the Diagnostic Conceptualization of CRPS-1 (Formerly Conceptualized as RSD)

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2006.marapr01 ◽

2006 ◽

Vol 11 (2) ◽

pp. 1-3, 9-12

Author(s):

Robert J. Barth ◽

Tom W. Bohr

Keyword(s):

Clinical Practice ◽

Complex Regional Pain Syndrome ◽

Somatoform Disorders ◽

International Association ◽

Pain Syndrome ◽

Somatoform Disorder ◽

Syndrome Type ◽

Previous Issue

Abstract From the previous issue, this article continues a discussion of the potentially confusing aspects of the diagnostic formulation for complex regional pain syndrome type 1 (CRPS-1) proposed by the International Association for the Study of Pain (IASP), the relevance of these issues for a proposed future protocol, and recommendations for clinical practice. IASP is working to resolve the contradictions in its approach to CRPS-1 diagnosis, but it continues to include the following criterion: “[c]ontinuing pain, which is disproportionate to any inciting event.” This language only perpetuates existing issues with current definitions, specifically the overlap between the IASP criteria for CRPS-1 and somatoform disorders, overlap with the guidelines for malingering, and self-contradiction with respect to the suggestion of injury-relatedness. The authors propose to overcome the last of these by revising the criterion: “[c]omplaints of pain in the absence of any identifiable injury that could credibly account for the complaints.” Similarly, the overlap with somatoform disorders could be reworded: “The possibility of a somatoform disorder has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a somatoform scenario.” The overlap with malingering could be addressed in this manner: “The possibility of malingering has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a malingering scenario.” The article concludes with six recommendations, and a sidebar discusses rating impairment for CRPS-1 (with explicit instructions not to use the pain chapter for this purpose).

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