Journal ArticleDOI
Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes
Christoph Maier,R. Baron,Thomas R. Tölle,Andreas Binder,Niels Birbaumer,Frank Birklein,Janne Gierthmühlen,Herta Flor,Christian Geber,Volker Huge,Elena K. Krumova,G. B. Landwehrmeyer,Walter Magerl,Christian Maihöfner,Helmut Richter,Roman Rolke,Andrea Scherens,A. Schwarz,Claudia Sommer,V. Tronnier,Nurcan Üçeyler,Michael Valet,Gunnar Wasner,D.-R. Treede +23 more
TLDR
Somatosensory profiles with different combinations of loss and gain are shared across the major neuropathic pain syndromes, including thermal and mechanical hyperalgesias, which were most frequent in complex regional pain syndrome and peripheral nerve injury, allodynia in postherpetic neuralgia.Abstract:
Neuropathic pain is accompanied by both positive and negative sensory signs. To explore the spectrum of sensory abnormalities, 1236 patients with a clinical diagnosis of neuropathic pain were assessed by quantitative sensory testing (QST) following the protocol of DFNS (German Research Network on Neuropathic Pain), using both thermal and mechanical nociceptive as well as non-nociceptive stimuli. Data distributions showed a systematic shift to hyperalgesia for nociceptive, and to hypoesthesia for non-nociceptive parameters. Across all parameters, 92% of the patients presented at least one abnormality. Thermosensory or mechanical hypoesthesia (up to 41%) was more frequent than hypoalgesia (up to 18% for mechanical stimuli). Mechanical hyperalgesias occurred more often (blunt pressure: 36%, pinprick: 29%) than thermal hyperalgesias (cold: 19%, heat: 24%), dynamic mechanical allodynia (20%), paradoxical heat sensations (18%) or enhanced wind-up (13%). Hyperesthesia was less than 5%. Every single sensory abnormality occurred in each neurological syndrome, but with different frequencies: thermal and mechanical hyperalgesias were most frequent in complex regional pain syndrome and peripheral nerve injury, allodynia in postherpetic neuralgia. In postherpetic neuralgia and in central pain, subgroups showed either mechanical hyperalgesia or mechanical hypoalgesia. The most frequent combinations of gain and loss were mixed thermal/mechanical loss without hyperalgesia (central pain and polyneuropathy), mixed loss with mechanical hyperalgesia in peripheral neuropathies, mechanical hyperalgesia without any loss in trigeminal neuralgia. Thus, somatosensory profiles with different combinations of loss and gain are shared across the major neuropathic pain syndromes. The characterization of underlying mechanisms will be needed to make a mechanism-based classification feasible.read more
Citations
More filters
Journal ArticleDOI
Relieving pain in america: a blueprint for transforming prevention, care, education, and research
TL;DR: The National Academy of Sciences through its Institute of Medicine (IOM) has produced a major scholarly assessment of pain in America as mentioned in this paper, which is a tremendous contribution to the evolving nec...
Journal ArticleDOI
Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment
TL;DR: A better understanding of neuropathic pain and of the translation of pathophysiological mechanisms into sensory signs will lead to a more effective and specific mechanism-based treatment approach.
Journal ArticleDOI
Neuropathic pain: An updated grading system for research and clinical practice
Nanna B. Finnerup,Simon Haroutounian,Peter R. Kamerman,Ralf Baron,David L.H. Bennett,Didier Bouhassira,Giorgio Cruccu,Roy Freeman,Per Hansson,Turo Nurmikko,Srinivasa N. Raja,Andrew S.C. Rice,Andrew S.C. Rice,Jordi Serra,Blair H. Smith,Rolf-Detlef Treede,Troels S. Jensen +16 more
TL;DR: A revised grading system of possible, probable, and definite neuropathic pain from 2008 is presented with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the “definite” level of neuropathicPain does not always indicate causality.
Journal ArticleDOI
Clinical features and pathophysiology of complex regional pain syndrome
Johan Marinus,G. Lorimer Moseley,G. Lorimer Moseley,Frank Birklein,Ralf Baron,Christian Maihöfner,Wade S. Kingery,Jacobus J. van Hilten +7 more
TL;DR: The evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury, and variation in susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS.
Journal ArticleDOI
Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms
TL;DR: Better understanding of allodynia and hyperalgesia might provide clues to the underlying pathophysiology of neuropathic pain and, as such, they represent new or additional endpoints in pain trials.
References
More filters
Journal ArticleDOI
The International Classification of Headache Disorders: 2nd edition
Journal ArticleDOI
Neuropathic pain Redefinition and a grading system for clinical and research purposes
Rolf-Detlef Treede,Troels S. Jensen,James N. Campbell,Giorgio Cruccu,Jonathan O. Dostrovsky,J. W. Griffin,Per Hansson,Richard A. C. Hughes,Turo Nurmikko,Jordi Serra +9 more
TL;DR: A grading system of definite, probable, and possible neuropathic pain is proposed, which includes the grade possible, which can only be regarded as a working hypothesis, and the grades probable and definite, which require confirmatory evidence from a neurologic examination.
Journal ArticleDOI
Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values
Roman Rolke,Ralf Baron,Christoph Maier,Thomas R. Tölle,Rolf-Detlef Treede,Antje Beyer,Andreas Binder,Niels Birbaumer,Frank Birklein,I. C. Bötefür,S. Braune,Herta Flor,Volker Huge,R. Klug,G. B. Landwehrmeyer,Walter Magerl,Christian Maihöfner,C. Rolko,C. Schaub,Andrea Scherens,Till Sprenger,Michael Valet,B. Wasserka +22 more
TL;DR: Application of this standardized QST protocol in patients and human surrogate models will allow to infer underlying mechanisms from somatosensory phenotypes as well as judge plus or minus signs in patients.
Journal ArticleDOI
Quantitative sensory testing: a comprehensive protocol for clinical trials
Roman Rolke,Walter Magerl,K. Andrews Campbell,C. Schalber,S. Caspari,Frank Birklein,Rolf-Detlef Treede +6 more
TL;DR: A comprehensive QST protocol is compiled using well established tests for nearly all aspects of somatosensation to test for patterns of sensory loss or gain, and to assess both cutaneous and deep pain sensitivity.
Related Papers (5)
Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values
Roman Rolke,Ralf Baron,Christoph Maier,Thomas R. Tölle,Rolf-Detlef Treede,Antje Beyer,Andreas Binder,Niels Birbaumer,Frank Birklein,I. C. Bötefür,S. Braune,Herta Flor,Volker Huge,R. Klug,G. B. Landwehrmeyer,Walter Magerl,Christian Maihöfner,C. Rolko,C. Schaub,Andrea Scherens,Till Sprenger,Michael Valet,B. Wasserka +22 more