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Trocmet L, Dufour A, Pebayle T, Després O, Lithfous S. Early detection of altered cold perception in elderly with type 2 diabetes using a novel Quantitative Sensory Testing method. Diabetes Metab Syndr 2024; 18:103097. [PMID: 39128379 DOI: 10.1016/j.dsx.2024.103097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 07/29/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Abstract
AIM To compare the effectiveness of two methods for measuring cold detection thresholds in screening for temperature-perception deficits in elderly individuals with type 2 diabetes (T2 diabetes). METHODS Cold threshold measurements were performed on seven body regions of participants with diabetes without neuropathy (n = 30; mean age, 70.9 ± 6.5 years) and healthy participants (n = 73; mean age, 68 ± 5 years). Two protocols applying the Levels Method were used: the first used skin temperature as the starting point; the second used 40 °C. RESULTS Cold detection thresholds were significantly higher in subjects with diabetes, particularly on the foot. For CDT TSk, values were -2.22 ± 1.91 °C in non-diabetic and -3.27 ± 3.33 °C in diabetic groups (p = 0.023); for CDT 40, values were -9.82 ± 3.5 °C and -12.18 ± 4.5 °C (p = 0.003). However, after adjusting for age, the group effect on cold threshold with skin temperature as baseline disappeared. Sensory screens showed that the Area Under Curve of the method using a 40 °C baseline was 0.69 (p = 0.002). CONCLUSION Measuring the cold detection threshold on the foot with a 40 °C baseline is more effective than using skin temperature as a baseline for screening sensory alterations in elderly subjects with type 2 diabetes before neuropathy onset. SIGNIFICANCE These findings highlight the importance of selecting the appropriate cold detection threshold method for elderly individuals with type 2 diabetes. The optimal method can facilitate early identification of sensory changes, minimizing complications and improving overall well-being.
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Affiliation(s)
- Louise Trocmet
- Laboratoire de Neurosciences Cognitives et Adaptatives, Université de Strasbourg, CNRS, UMR 7364, LNCA, 12 rue Goethe, 67000, Strasbourg, France.
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptatives, Université de Strasbourg, CNRS, UMR 7364, LNCA, 12 rue Goethe, 67000, Strasbourg, France; Centre d'Investigations Neurocognitives et Neurophysiologiques, Université de Strasbourg, CNRS, UMS 3489, CI2N, 21 rue Becquerel, 67087, Strasbourg, France
| | - Thierry Pebayle
- Centre d'Investigations Neurocognitives et Neurophysiologiques, Université de Strasbourg, CNRS, UMS 3489, CI2N, 21 rue Becquerel, 67087, Strasbourg, France
| | - Olivier Després
- Laboratoire de Neurosciences Cognitives et Adaptatives, Université de Strasbourg, CNRS, UMR 7364, LNCA, 12 rue Goethe, 67000, Strasbourg, France
| | - Ségolène Lithfous
- Laboratoire de Neurosciences Cognitives et Adaptatives, Université de Strasbourg, CNRS, UMR 7364, LNCA, 12 rue Goethe, 67000, Strasbourg, France
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Gaur A, Varatharajan S, Taranikanti M, John NA, Kalpana M, Ganji V, Umesh M, Katta R. Inter-trial Variation in the Sensitivity of Thermal Threshold Testing for the Diagnosis of Neuropathy in Type 2 Diabetes Mellitus. Int J Appl Basic Med Res 2024; 14:182-186. [PMID: 39310082 PMCID: PMC11412566 DOI: 10.4103/ijabmr.ijabmr_207_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 09/25/2024] Open
Abstract
Background Thermal threshold testing (TTT) is a simple non-invasive approach for diagnosing diabetic neuropathy earlier. Conventionally the TTT is done in all four limbs and at least 6 trials are done to obtain the mean threshold, which is time consuming. Aim We propose to assess the validity and reliability of reduced number of trials of TTT in the lower limbs. Materials and Methods After obtaining ethics approval from the Institute Ethics Committee, 100 patients with type 2 Diabetes Mellitus of both gender between the ages of 35 to 65 years attending medicine OPD were recruited. Neuropathy assessment was done using Temperature threshold testing. At least 6 trials were performed for each site and the mean threshold obtained. The mean of 5 trials, 4 trials and 3 trials were noted for the comparison. Results On comparing hot tests of 3 trials with 6 trials had a sensitivity and specificity of 88.7% and 96.6 %. In cold threshold testing, 4 trials and 3 trials showed similar results of sensitivity of 77.8%, specificity of 98.8%. The measures of agreement between the hot trials 6 vs 5 had Kappa value of 0.953, 6vs 4 showed a Kappa value of 0.862 and 6 vs 3 showed Kappa value of 0.819. Conclusion Hot threshold tests of lower limb are more sensitive than cold thresholds. The 4 trial test is a reliable test and can be performed over 6 trial tests. When time is a factor, three trials are sufficient to diagnose small fibre neuropathy.
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Affiliation(s)
- Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | | | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Nitin Ashok John
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Medala Kalpana
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Roja Katta
- Department of Physiology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
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Gaur A, Varatharajan S, Katta R, Taranikanti M, John NA, Umesh M, Ganji V, Medala K. Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus. Int J Appl Basic Med Res 2024; 14:54-59. [PMID: 38504834 PMCID: PMC10947757 DOI: 10.4103/ijabmr.ijabmr_397_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/05/2024] [Accepted: 01/19/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile. Materials and Methods The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT. Results The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation. Conclusion The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.
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Affiliation(s)
- Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Roja Katta
- Department of Physiology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Nitin Ashok John
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kalpana Medala
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
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Crucianelli L, Radziun D, Ehrsson HH. Thermosensation and emotion: Thermosensory accuracy in a dynamic thermal matching task is linked to depression and anxiety symptomatology. Physiol Behav 2024; 273:114407. [PMID: 37967806 DOI: 10.1016/j.physbeh.2023.114407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
Interoception is related to the generation of bodily feelings and the awareness of ourselves as 'sentient beings', informing the organism about its bodily needs to guarantee survival. Previous studies have reported links among interoception, emotion processing, and mental health. For example, the alignment of interoceptive dimensions (i.e., accuracy, sensibility, awareness) can predict emotional symptoms, such as anxiety. Here, we aimed to investigate the relationship between the perception of a certain type of skin-mediated interoceptive signal, i.e., thermosensation, and self-reported depression, anxiety, and stress. One hundred seventy participants completed the Depression Anxiety Stress Scale (DASS-21) and a dynamic thermal matching task, a static temperature detection task, and a heartbeat counting task. Our results revealed that self-reported anxiety and depression were related to the perception of temperature on hairy and non-hairy skin, respectively: higher anxiety was related to better performance on the thermal matching task on the forearm, while higher depression was related to poorer performance on dynamic and static temperature tasks on the palm. Discrepancies between thermosensory accuracy and sensibility measures ('trait prediction error') were related to heightened anxiety, in line with previous studies. No significant correlations were found between DASS-21 scores and heartbeat counting accuracy. In conclusion, this study suggests that individual differences in thermosensory perception in different areas of the body are associated with self-reported anxiety and depression.
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Affiliation(s)
- Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, UK.
| | - Dominika Radziun
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - H Henrik Ehrsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Zillinger M, Joseph L, Corten L. Test-Retest reliability and concurrent validity of novel nerve testing device for thermal detection and thermal pain thresholds. J Med Eng Technol 2023; 47:131-140. [PMID: 36129006 DOI: 10.1080/03091902.2022.2118382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thermal threshold testing is important for evaluating the thermal function of small-fibre nerve types C and A-delta. This study investigated the reliability and validity of a novel nerve testing device (NNTD) in evaluating thermal detection and thermal pain thresholds. Test-retest reliability of the NNTD and its concurrent validity compared to the current technology (Medoc TSA-2, Advanced Thermosensory Stimulator, Israel) were investigated among 10 healthy participants. Each participant was tested for the warm detection threshold (WDT), cold detection threshold (CDT), hot pain threshold (HPT) and cold pain threshold (CPT) on the medial forearm with NNTD for two trials and the Medoc TSA-2 for one trial over two consecutive days. Intraclass Correlation Coefficient values, Standard Error of Measurement and Bland Altman plots were calculated for test-retest reliability. One-way ANOVA and Bland Altman plots were calculated for validity. The test-retest reliability of the NNTD was good for CPT (ICC = 0.88), moderate for WDT (ICC = 0.545) and HPT (ICC = 0.710). The NNTD was valid for both trials of HPT and CPT and one trial for WDT compared to the Medoc TSA-2. In conclusion, the NNTD showed good to moderate reliability and was found to be valid compared to the Medoc TSA-2.
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Affiliation(s)
- Monika Zillinger
- School of Sports and Health Sciences, University of Brighton, Eastbourne, East Sussex, The United Kingdom
| | - Leonard Joseph
- School of Sports and Health Sciences, University of Brighton, Eastbourne, East Sussex, The United Kingdom
| | - Lieselotte Corten
- School of Sports and Health Sciences, University of Brighton, Eastbourne, East Sussex, The United Kingdom
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The impact of pregnancy and childbirth on pelvic sensation: a prospective cohort study. Sci Rep 2023; 13:1535. [PMID: 36707642 PMCID: PMC9883213 DOI: 10.1038/s41598-023-28323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023] Open
Abstract
Pelvic organ prolapse, urinary, bowel and sexual dysfunction, collectively called pelvic floor dysfunction (PFD) affects 1 in 3 women and has a significant public health impact. The causes of PFD are not fully understood but involve injury to connective tissue and motor nerve during childbirth. Women with PFD also have sensory nerve impairment, and it is likely this occurs during childbirth, but this has never been investigated. In the current study 150 women underwent quantitative sensory testing for vibration sensation at the vagina and clitoris, and stretch sensation at the vagina and introitus, in the third trimester, 3 and 6 months postnatal. Antenatally vibration sensation was reduced but stretch sensation was normal. Postnatally vibration sensation deteriorated whilst stretch sensation initially deteriorated but recovered by 6 months postnatal to antenatal levels (all p < 0.001). Mode of birth had a significant impact on sensation, with caesarean section appearing neuroprotective, normal vaginal birth resulted in a transient deterioration in sensation that recovered by 6 months, whilst assisted vaginal delivery was prolonged suggesting persistent neurological impairment (all p < 0.015). Further research is required to study the clinical effect of these changes on pelvic floor dysfunction in the medium and long-term.
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Robayo LE, Govind V, Vastano R, Felix ER, Fleming L, Cherup NP, Widerström-Noga E. Multidimensional pain phenotypes after Traumatic Brain Injury. FRONTIERS IN PAIN RESEARCH 2022; 3:947562. [PMID: 36061413 PMCID: PMC9437424 DOI: 10.3389/fpain.2022.947562] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
More than 50% of individuals develop chronic pain following traumatic brain injury (TBI). Research suggests that a significant portion of post-TBI chronic pain conditions is neuropathic in nature, yet the relationship between neuropathic pain, psychological distress, and somatosensory function following TBI is not fully understood. This study evaluated neuropathic pain symptoms, psychological and somatosensory function, and psychosocial factors in individuals with TBI (TBI, N = 38). A two-step cluster analysis was used to identify phenotypes based on the Neuropathic Pain Symptom Inventory and Beck's Anxiety Inventory scores. Phenotypes were then compared on pain characteristics, psychological and somatosensory function, and psychosocial factors. Our analyses resulted in two different neuropathic pain phenotypes: (1) Moderate neuropathic pain severity and anxiety scores (MNP-AS, N = 11); and (2) mild or no neuropathic pain symptoms and anxiety scores (LNP-AS, N = 27). Furthermore, the MNP-AS group exhibited greater depression, PTSD, pain severity, and affective distress scores than the LNP-AS group. In addition, thermal somatosensory function (difference between thermal pain and perception thresholds) was significantly lower in the MNP-AS compared to the LNP-AS group. Our findings suggest that neuropathic pain symptoms are relatively common after TBI and are not only associated with greater psychosocial distress but also with abnormal function of central pain processing pathways.
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Affiliation(s)
- Linda E. Robayo
- Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL, United States
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
| | - Varan Govind
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Roberta Vastano
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Elizabeth R. Felix
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Loriann Fleming
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Nicholas P. Cherup
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Eva Widerström-Noga
- Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL, United States
- Christine E. Lynn Rehabilitation Center, Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Eva Widerström-Noga
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Hojatmadani M, Rigsby B, Reed KB. Time Delay Affects Thermal Discrimination. IEEE TRANSACTIONS ON HAPTICS 2022; 15:451-457. [PMID: 35259114 DOI: 10.1109/toh.2022.3156122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Time order errors have been investigated in several fields, and the time delay between subsequent stimuli in discrimination tasks is one example of such errors. However, the effect of these types of errors in thermal discrimination tasks is understudied. To evaluate the effect of inter-stimulus interval (ISI) on thermal perception, we used a discrimination task with a staircase method between two non-zero thermal stimuli. We found that JND ISI=0s was 3.10 and increased by 11.9% and 21.2% at JND ISI=3s and JND ISI=9s, respectively. Statistical analysis revealed that ISI was a statistically significant effect ( ) on thermal perception in our task. Future studies on thermal perception should keep the ISI consistent and report the time.
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Verdugo RJ, Matamala JM, Inui K, Kakigi R, Valls-Solé J, Hansson P, Bernhard Nilsen K, Lombardi R, Lauria G, Petropoulos IN, Malik RA, Treede RD, Baumgärtner U, Jara PA, Campero M. Review of techniques useful for the assessment of sensory small fiber neuropathies: Report from an IFCN expert group. Clin Neurophysiol 2022; 136:13-38. [DOI: 10.1016/j.clinph.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/09/2023]
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Johnson AJ, Wilson AT, Laffitte Nodarse C, Montesino-Goicolea S, Valdes-Hernandez PA, Somerville J, Peraza JA, Fillingim RB, Bialosky J, Cruz-Almeida Y. Age Differences in Multimodal Quantitative Sensory Testing and Associations With Brain Volume. Innov Aging 2021; 5:igab033. [PMID: 34616958 PMCID: PMC8489433 DOI: 10.1093/geroni/igab033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Somatosensory function is critical for successful aging. Prior studies have shown declines in somatosensory function with age; however, this may be affected by testing site, modality, and biobehavioral factors. While somatosensory function declines are associated with peripheral nervous system degradation, little is known regarding correlates with the central nervous system and brain structure in particular. The objectives of this study were to examine age-related declines in somatosensory function using innocuous and noxious stimuli, across 2 anatomical testing sites, with considerations for affect and cognitive function, and associations between somatosensory function and brain structure in older adults. RESEARCH DESIGN AND METHODS A cross-sectional analysis included 84 "younger" (n = 22, age range: 19-24 years) and "older" (n = 62, age range: 60-94 years) healthy adults who participated in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan study. Participants were assessed on measures of somatosensory function (quantitative sensory testing), at 2 sites (metatarsal and thenar) using standardized procedures, and completed cognitive and psychological function measures and structural magnetic resonance imaging. RESULTS Significant age × test site interaction effects were observed for warmth detection (p = .018,η p 2 = 0.10) and heat pain thresholds (p = .014,η p 2 = 0.12). Main age effects were observed for mechanical, vibratory, cold, and warmth detection thresholds (ps < .05), with older adults displaying a loss of sensory function. Significant associations between somatosensory function and brain gray matter structure emerged in the right occipital region, the right temporal region, and the left pericallosum. DISCUSSION AND IMPLICATIONS Our findings indicate healthy older adults display alterations in sensory responses to innocuous and noxious stimuli compared to younger adults and, furthermore, these alterations are uniquely affected by anatomical site. These findings suggest a nonuniform decline in somatosensation in older adults, which may represent peripheral and central nervous system alterations part of aging processes.
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Affiliation(s)
- Alisa J Johnson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Abigail T Wilson
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Brooks Rehabilitation–College of Public Health and Health Professions Research Collaboration, Gainesville, Florida, USA
| | - Chavier Laffitte Nodarse
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Soamy Montesino-Goicolea
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Pedro A Valdes-Hernandez
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Jessie Somerville
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Julio A Peraza
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Joel Bialosky
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Brooks Rehabilitation–College of Public Health and Health Professions Research Collaboration, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
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Mindfulness-Based Analgesia or Placebo Effect? The Development and Evaluation of a Sham Mindfulness Intervention for Acute Experimental Pain. Psychosom Med 2021; 83:557-565. [PMID: 33165219 DOI: 10.1097/psy.0000000000000886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Meta-analyses indicate that mindfulness meditation is efficacious for chronic and acute pain, but most available studies lack active control comparisons. This raises the possibility that placebo-related processes may account, at least in part, for mindfulness effects. The objective of this study was to develop a closely matched sham mindfulness condition to establish whether placebo effects contribute to mindfulness-based interventions for pain. METHODS We developed and validated a closely matched sham mindfulness intervention then compared it with 6 × 20-minute sessions of focused-attention mindfulness and a no-treatment condition in 93 healthy volunteers undergoing acute experimental heat pain. RESULTS The sham mindfulness intervention produced equivalent credibility ratings and expectations of improvement as the mindfulness intervention but did not influence mindfulness-related processes. In contrast, mindfulness increased "observing" relative to no treatment but not sham. Mindfulness (F(1,88) = 7.06, p = .009, ηp2 = 0.07) and sham (F(1,88) = 6.47, p = .012, ηp2 = 0.07) moderately increased pain tolerance relative to no treatment, with no difference between mindfulness and sham (F(1,88) = 0.01, p = .92, ηp2 < 0.001). No differences were found for pain threshold. Similarly, neither mindfulness nor sham reduced pain intensity or unpleasantness relative to no treatment, although mindfulness reduced pain unpleasantness relative to sham (F(1,88) = 5.03, p = .027, ηp2 = 0.05). CONCLUSIONS These results suggest that placebo effects contribute to changes in pain tolerance after mindfulness training, with limited evidence of specific effects of mindfulness training on pain unpleasantness relative to sham, but not no treatment. To disentangle the specific analgesic effects of mindfulness from placebo-related processes, future research should prioritize developing and incorporating closely matched sham conditions.Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12618001175268).
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Dunker Ø, Lie M, Nilsen K. Can within-subject comparisons of thermal thresholds be used for diagnostic purposes? Clin Neurophysiol Pract 2021; 6:63-71. [PMID: 33665518 PMCID: PMC7905396 DOI: 10.1016/j.cnp.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/23/2020] [Accepted: 01/04/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Quantitative thermal testing (QTT) is a psychophysical assessment method of small nerve fibers that relies on reference material to assess function. Normal limits for within-subject comparisons of thermal thresholds are scarce, and their association with age, height and sex is not fully elucidated. The aim of this study was to investigate the normal limits for distal-proximal- and contralateral homologous comparisons of thermal thresholds with QTT, and their association with age, sex or height. METHODS Fifty healthy volunteers ages 20-79 participated in the experiment. Cold detection thresholds (CDT), warm detection thresholds (WDT), heat pain thresholds (HPT), and cold pain thresholds (CPT) were measured bilaterally at the thenar eminence, anterior thigh, distal medial leg and foot dorsum. Sample normal limits were calculated as (mean) ± 2 SD. RESULTS Forty-eight subjects were included in the analysis. CPT was excluded from all analyses due to a large floor-effect. Sample normal limits for side-differences ranged from 1.8 to 7.2 °C for CDT, 2.4-6.8 °C for WDT and 3.2-4.0 °C for HPT, depending on anatomical site. For distal-proximal comparisons, sample normal limits ranged from 4.0 to 8.7 °C for CDT, 6.0-14.0 °C for WDT and 4.2-9.0 °C for HPT, depending on the pairs compared. Age was associated with side-differences for CDT in the thenar eminences (p < 0.001) and distal medial legs (p < 0.002), and with 11 of 18 distal-proximal comparisons (p < 0.01). CONCLUSIONS The normal limits for distal-proximal- and contralateral homologous thermal thresholds were wide, and thus of limited use in a clinical setting, although the reported values may be somewhat inflated by low sample-size and consequent age-pooling. Age, but not sex or height, was associated with contralateral differences in CDT in the thenar eminences and distal medial legs, and with most distal-proximal differences. SIGNIFICANCE Due to wide normal limits, we advise caution when utilizing relative comparisons of thermal thresholds for diagnostic purposes.
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Affiliation(s)
- Ø. Dunker
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Oslo, Norway
| | - M.U. Lie
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - K.B. Nilsen
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
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Sensory alteration patterns in burned patients. Burns 2020; 46:1729-1736. [DOI: 10.1016/j.burns.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/28/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
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A test-retest reliability study of assessing small cutaneous fibers by measuring current perception threshold with pin electrodes. PLoS One 2020; 15:e0242490. [PMID: 33201884 PMCID: PMC7671533 DOI: 10.1371/journal.pone.0242490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022] Open
Abstract
Background The quantitative measurement of current perception threshold (CPT) has been used as a method to assess the function of nerve fibers in neuropathy diseases. The aim of this study was to assess the test-retest reliability measuring CPT using the circular pin electrodes for assessing the function of cutaneous thin nerve fibers. Methods CPT measurement was repeated on two separate days with at least one-week interval in 55 volunteers. Superficial blood flow (SBF) and skin temperature (ST) were measured on the skin in an around area concentric to the circular pin electrodes after the process of finding CPTs. The coefficient of variation (CV) and intra-class correlation coefficient (ICC) were calculated. The correlation between each two of CPT, SBF increment and ST increment was analyzed. Results No significant differences were found for CPT, SBF and ST between two sessions. SBF was found to be significantly increased after the process of finding CPT. CPT values of males were found to be higher than females. SBF increment was found to be positively correlated with ST increment. The ICC values for CPT, SBF and ST were 0.595, 0.852 and 0.728, respectively. The CV values for CPT, SBF and ST were 25.53%, 12.59% and 1.94%, respectively. Conclusions The reliability of CPT measurement using circular pin electrodes is fair, and need consistence of measurements in longitudinal studies.
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Thermal sensitivity mapping - warmth and cold detection thresholds of the human torso. J Therm Biol 2020; 93:102718. [PMID: 33077130 DOI: 10.1016/j.jtherbio.2020.102718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Skin as the largest organ of the human body accomplishes many important functions, including thermoregulation. In this context, investigating cold (CDT) and warmth detection thresholds (WDT) constitutes an important research branch, and investigating thermal thresholds has a significant impact on the clothing and fabric textile industry. In this regard, not only the extremities, but also torso regions are of high relevance. However, only few examinations have conducted detailed mapping studies of the human torso. Additionally, some of these studies show certain methodological limitations. Furthermore, the issue of whether cutaneous thermal sensitivity is gender-dependent is still controversial. Therefore, the present study investigated the cutaneous thermal sensitivity (CDT, WDT) of 42 male and female young and healthy subjects. Measurements were taken at 11 anatomical regions. We found that gender plays an important role when investigating thermal thresholds: Females tended to be more sensitive than males. We also found considerable differences between the tested regions, even within the anterior torso, for example. We identified locations which were constantly sensitive (lower back), while others were consistently insensitive (e.g. scapula). We also detected greater data variability for males compared to females, and for WDT compared to CDT. Furthermore, mainly for WDT, we found a proximal-to-distal increase of thermal torso and upper arm sensitivity. In line with previous investigations, our subjects were more sensitive to cold than to warmth. The findings of this study have important implications. First, our data may complement basic research, e.g. in terms of reference data of body regional maps. Second, our data provides important insights that could be leveraged in the textile industry, and also used to optimize current broadly applicable test methods and tools, like thermal manikins and thermophysiological models.
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Svanborg E, Ulander M, Broström A, Sunnergren O. Palatal Sensory Function Worsens in Untreated Snorers but not in CPAP-Treated Patients With Sleep Apnea, Indicating Vibration-Induced Nervous Lesions. Chest 2020; 157:1296-1303. [PMID: 32059960 DOI: 10.1016/j.chest.2020.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Signs of both motor and sensory nervous lesions have previously been shown in the upper airway of patients with OSA and habitual snorers. Snoring per se may damage all upper airway neurons over time, thereby causing progression to manifest sleep apnea. To test this hypothesis, nonsnoring subjects, untreated snorers, and CPAP-treated patients underwent repeated sensory testing of the soft palate in a prospective long-term study. METHODS Cold detection threshold (CDT) testing at the soft palate and lip with a thermode and nocturnal respiratory recordings were performed in 2008 to 2009 with retesting 6 to 7 years later. RESULTS In 25 untreated snorers, palatal CDT worsened from a median (25th-75th percentile range) 4.2°C (3.2-5.9) to 11.0°C (7.0-17.4) (P < .001). The apnea-hypopnea index increased from a median 7.0 to 14.0 events/h (P < .05). There was no significant correlation between changes in CDT and the apnea-hypopnea index. In 21 nonsnoring control subjects, palatal CDT increased from a median 3.2°C to 5.6°C (P < .005). In 19 CPAP-treated patients, palatal CDT did not significantly change; eight patients had improved values. CDTs worsened significantly more in the snorers group than in the control subjects (P < .05) and the CPAP-treated patients (P < .001). There was no significant difference between control subjects and CPAP-treated patients. CONCLUSIONS CDT worsened considerably over time in untreated snorers, significantly more than in nonsnoring control subjects and CPAP-treated patients. Untreated snorers therefore risk developing poor sensitivity in the upper airway. In contrast, efficient treatment of OSA seems to protect the sensory innervation, as the CPAP-treated group maintained their sensitivity to cold and, in some cases, the sensitivity even improved.
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Affiliation(s)
- Eva Svanborg
- Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Martin Ulander
- Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden
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Mahoney C, Chok SM, Bryant A, Myers J, Smith A, Reid F. Method of limits: Female genital stretch perception thresholds. Neurourol Urodyn 2020; 39:778-784. [PMID: 31961957 DOI: 10.1002/nau.24282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/08/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Women with pelvic organ prolapse describe vaginal laxity and poor sensation of vaginal tone that does not correlate with anatomical findings. This discrepancy could be explained by altered vaginal sensation and a test that could measure sensation of vaginal tone, transmitted via Aα and Aβ nerve fibers, would further our understanding of the pathophysiology of vaginal laxity. OBJECTIVE To develop quantitative sensory testing (QST) for vaginal tone using genital stretch perception thresholds (PT), assess reproducibility, and the association with age and parity. STUDY DESIGN Prospective observational cohort study of healthy women (Canadian task force classification II-2) who underwent QST method of limits at the vagina and introitus for sensation of first awareness and stretch using a modified anorectal physiology protocol. RESULTS Forty women underwent repeatability testing. Intra- and inter-rater repeatability using intraclass correlation coefficients (ICC) was good to excellent for both first awareness and stretch at the vagina and introitus (intra-rater ICC = 0.93, 0.95, 0.81, and 0.88, respectively; inter-rater ICC = 0.83, 0.93, 0.71, and 0.86 respectively). Normative data were collected from 100 women. Log-linear regression found a significant association between age and PT for first awareness and stretch at the vagina and introitus (P = .020, .008, .002, and <.001, respectively). There was no association with parity and PT. Nomograms were calculated using the 95% confidence limits around the regression line. CONCLUSIONS Stretch QST is clinically feasible, valid, and reproducible. The test can be used as a tool to measure sensation in women presenting with symptoms of vaginal laxity.
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Affiliation(s)
- Charlotte Mahoney
- Department of Urogynaecology, The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Materno-Fetal Health Research Group, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK
| | - Sok-Moi Chok
- Obstetrics and Gynaecology Division, Lancashire Women and Newborn Centre, Burnley General Hospital, East Lancashire NHS Trust, Burnley, UK
| | - Angela Bryant
- Department of Urogynaecology, The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jenny Myers
- Materno-Fetal Health Research Group, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK
| | - Anthony Smith
- Department of Urogynaecology, The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Fiona Reid
- Department of Urogynaecology, The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Kappers AML, Plaisier MA. Thermal Perception and Thermal Devices Used on Body Parts Other Than Hand or Face. IEEE TRANSACTIONS ON HAPTICS 2019; 12:386-399. [PMID: 31251195 DOI: 10.1109/toh.2019.2925339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most fundamental research on thermal perception focuses on the fingers or the hand. Also most existing and proposed thermal devices are meant to be applied to hand or fingers. However, if the hands are needed for other tasks, application of thermal stimulation to other body regions should be considered. This paper surveys the literature on thermal perception and thermal devices relevant to such other body regions. It starts with a short description of the experimental methods used in the various studies, such as the methods of limits, the two-alternative forced choice method, and magnitude estimation. This is followed by thermal psychophysical studies on detection, adaptation, spatial summation, and resolution. Next some striking thermal illusions are presented, such as a thermal grill and a seemingly continuously warming or cooling stimulus. Finally, the few studies on thermal communication and applications are summarized. These latter studies mainly focus on communicating emotions or playing computer games. The overall conclusion of this survey is that thermal devices should not focus on conveying complex messages, but especially in the areas of gaming or communication there seem to be interesting possibilities for further developments.
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Zhu GC, Böttger K, Slater H, Cook C, Farrell SF, Hailey L, Tampin B, Schmid AB. Concurrent validity of a low-cost and time-efficient clinical sensory test battery to evaluate somatosensory dysfunction. Eur J Pain 2019; 23:1826-1838. [PMID: 31325385 PMCID: PMC6852113 DOI: 10.1002/ejp.1456] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/27/2019] [Accepted: 07/08/2019] [Indexed: 02/02/2023]
Abstract
Background This study describes a low‐cost and time‐efficient clinical sensory test (CST) battery and evaluates its concurrent validity as a screening tool to detect somatosensory dysfunction as determined using quantitative sensory testing (QST). Method Three patient cohorts with carpal tunnel syndrome (CTS, n = 76), non‐specific neck and arm pain (NSNAP, n = 40) and lumbar radicular pain/radiculopathy (LR, n = 26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using thermal (coins, ice cube, hot test tube) and mechanical (cotton wool, von Frey hairs, tuning fork, toothpicks, thumb and eraser pressure) detection and pain thresholds testing both loss and gain of function. Agreement rate, statistical significance and strength of correlation (phi coefficient) between CST and QST parameters were calculated. Results Several CST parameters (cold, warm and mechanical detection thresholds as well as cold and pressure pain thresholds) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and moderate to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger agreement in the CTS and LR cohorts, whereas loss of function parameters had better agreement in the NSNAP cohort. Other CST parameters (16 mN von Frey tests, vibration detection, heat and mechanical pain thresholds, wind‐up ratio) did not significantly correlate with QST. Conclusion Some of the tests in the CST could help detect somatosensory dysfunction as determined with QST. Parts of the CST could therefore be used as a low‐cost screening tool in a clinical setting. Significance Quantitative sensory testing, albeit considered the gold standard to evaluate somatosensory dysfunction, requires expensive equipment, specialized examiner training and substantial time commitment which challenges its use in a clinical setting. Our study describes a CST as a low‐cost and time‐efficient alternative. Some of the CST tools (cold, warm, mechanical detection thresholds; pressure pain thresholds) significantly correlated with the respective QST parameters, suggesting that they may be useful in a clinical setting to detect sensory dysfunction.
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Affiliation(s)
- Guan Cheng Zhu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
| | - Karina Böttger
- Centre of Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Chad Cook
- Department of Orthopaedics, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Scott F Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Louise Hailey
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Brigitte Tampin
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Department of Physiotherapy, Neurosurgery Spinal Clinic, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Faculty of Business Management and Social Sciences, Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| | - Annina B Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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