Sensory signs in complex regional pain syndrome and peripheral nerve injury

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• 作者：Janne Gierthmü ; hlen^a ; ¹ ; ^{j.gierthmuehlen@neurologie.uni-kiel.de} ; Christoph Maier^b ; ¹ ; ² ; Ralf Baron^a ; ² ; Thomas Tö ; lle^c ; ² ; Rolf-Detlef Treede^d ; ² ; Niels Birbaumer^e ; Volker Huge^f ; Jana Koroschetz^a ; Elena K. Krumova^b ; Meike Lauchart^f ; Christian Maihö ; fner^g ; Helmut Richter^b ; Andrea Westermann^b ; the German Research Network on Neuropathic Pain (DFNS) study group³
• 关键词：Complex regional pain syndrome ; CRPS ; Peripheral nerve injury ; Quantitative sensory testing ; Somatosensory ; Pain
• 刊名：Pain
• 出版年：2012
• 期刊代码：214_03043959
• 类别：med
• 出版时间：April, 2012
• 卷：153
• 期：4
• 页码：765-774
• 文件大小：298 K

摘要

This study determined patterns of sensory signs in complex regional pain syndrome (CRPS) type I and II and peripheral nerve injury (PNI). Patients with upper-limb CRPS-I (n = 298), CRPS-II (n = 46), and PNI (n = 72) were examined with quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain. The majority of patients (66%-69%) exhibited a combination of sensory loss and gain. Patients with CRPS-I had more sensory gain (heat and pressure pain) and less sensory loss than patients with PNI (thermal and mechanical detection, hypoalgesia to heat or pinprick). CRPS-II patients shared features of CRPS-I and PNI. CRPS-I and CRPS-II had almost identical somatosensory profiles, with the exception of a stronger loss of mechanical detection in CRPS-II. In CRPS-I and -II, cold hyperalgesia/allodynia (28%-31%) and dynamic mechanical allodynia (24%-28%) were less frequent than heat or pressure hyperalgesia (36%-44%, 67%-73%), and mechanical hypoesthesia (31%-55%) was more frequent than thermal hypoesthesia (30%-44%). About 82%of PNI patients had at least one type of sensory gain. QST demonstrates more sensory loss in CRPS-I than hitherto considered, suggesting either minimal nerve injury or central inhibition. Sensory profiles suggest that CRPS-I and CRPS-II may represent one disease continuum. However, in contrast to recent suggestions, small fiber deficits were less frequent than large fiber deficits. Sensory gain is highly prevalent in PNI, indicating a better similarity of animal models to human patients than previously thought. These sensory profiles should help prioritize approaches for translation between animal and human research.