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Cosentino G, Antoniazzi E, Bonomi L, Cavigioli C, D'Agostino M, Todisco M, Tassorelli C. Age-, gender- and body site-specific reference values of thermal Quantitative Sensory Testing in the Italian population using the Q-sense device. Neurol Sci 2023; 44:4481-4489. [PMID: 37450073 PMCID: PMC10641050 DOI: 10.1007/s10072-023-06929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Age-, gender- and body site-specific values of thermal Quantitative Sensory Testing (QST) measures have not yet been reported using the novel and cheap device 'Q-sense'. Here, we aimed to assess normative values of Q-sense-derived parameters in a representative Italian population. METHODS QST parameters were measured in 84 healthy participants (42 males; aged 20-76 years) equally distributed into three age groups (18-39, 40-59 and 60-80 years). We explored the Warm and the Cold Detection Thresholds (WDT and CDT, respectively) with the method of limits (MLI) and the method of levels (MLE), and the Heat Pain Threshold (HPT) with the MLI. We tested the trigeminal supraorbital region, the hand thenar, and the foot dorsum on the right body side. RESULTS We calculated non-parametric reference limits (2.5-97.5th) according to age, gender and tested site. All QST measures were affected by age, gender and tested site. In the extra-trigeminal body sites, females showed lower WDT and higher CDT, while males had higher HPT. Worse sensory discriminative abilities and increased HPT values were found in people aged over 40 on the foot. Age-related differences were more evident with the reaction time-dependent MLI vs. MLE paradigm. CONCLUSIONS Demographic characteristics must be considered when QST is used in the clinical setting. The definition of reference limits for sensory testing with the Q-sense herein provided can pave the way towards a more widespread use of thermal QST for diagnosing small fiber neuropathy and for identifying patients' profiles in different chronic pain syndromes.
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Affiliation(s)
- Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Elisa Antoniazzi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Laura Bonomi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Camilla Cavigioli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | | | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
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Dunker Ø, Uglem M, Bu Kvaløy M, Løseth S, Hjelland IE, Allen SM, Dehli Vigeland M, Kleggetveit IP, Sand T, Nilsen KB. Diagnostic accuracy of the 5.07 monofilament test for diabetes polyneuropathy: influence of age, sex, neuropathic pain and neuropathy severity. BMJ Open Diabetes Res Care 2023; 11:e003545. [PMID: 37989346 PMCID: PMC10660161 DOI: 10.1136/bmjdrc-2023-003545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/13/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION There is a need for simple and cheap diagnostic tools for diabetic polyneuropathy (DPN). We aimed to assess the diagnostic accuracy of the 5.07/10 g monofilament test in patients referred to polyneuropathy assessments, as well as to examine how disease severity, age, sex and neuropathic pain (NP) impact diagnostic accuracy. RESEARCH DESIGN AND METHODS Five Norwegian university hospitals recruited patients with diabetes aged 18-70 referred to neurological outpatient clinics for polyneuropathy assessments. The 5.07/10 g Semmes-Weinstein monofilament examination (SWME) was validated against the Toronto consensus for diagnosing diabetic neuropathies; the results were stratified by age, sex and NP. Disease severity was graded by a combined nerve conduction study (NCS) Z-score, and logistic regression was applied to assess whether disease severity was a predictor of diagnostic accuracy. RESULTS In total, 506 patients were included in the study. Global sensitivity was 0.60 (95% CI 0.55, 0.66), specificity 0.82 (95% CI 0.75, 0.87), positive and negative predictive values were 0.86 (95% CI 0.81, 0.90) and 0.52 (95% CI 0.46, 0.58), respectively, positive and negative likelihood ratios were 3.28 (95% CI 2.37, 4.53) and 0.49 (95% CI 0.42, 0.57), respectively. The SWME was less sensitive in females (0.43), had lower specificity in patients with NP (0.56), and performed worse in patients ≥50 years. NCS-based disease severity did not affect diagnostic accuracy (OR 1.15, 95% CI 0.95, 1.40). CONCLUSIONS This multicenter study demonstrates poor diagnostic performance for the 5.07/10 g SWME in patients with diabetes referred to polyneuropathy assessments; it is particularly unsuited for female patients and those with NP. The diagnostic accuracy of the SWME was not influenced by NCS-based disease severity, demonstrating that it does not perform better in patients with later stages of DPN. We do not recommend the use of the 5.07/10 g monofilament in the evaluation of patients with diabetes referred to polyneuropathy assessments.
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Affiliation(s)
- Øystein Dunker
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Martin Uglem
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marie Bu Kvaløy
- Department of Neurology, Section of Clinical Neurophysiology, Stavanger University Hospital, Stavanger, Norway
| | - Sissel Løseth
- Department of Neurology and Clinical Neurophysiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Artic University of Norway, Tromsø, Norway
| | - Ina Elen Hjelland
- Department of Clinical Neurophysiology, Haukeland University Hospital, Bergen, Norway
| | - Sara Maria Allen
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | | | - Inge Petter Kleggetveit
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristian Bernhard Nilsen
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
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Ezquerra-Romano I, Chowdhury M, Leone CM, Iannetti GD, Haggard P. A novel method to selectively elicit cold sensations without touch. J Neurosci Methods 2023; 385:109763. [PMID: 36476749 DOI: 10.1016/j.jneumeth.2022.109763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/13/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Thermal and tactile stimuli are transduced by different receptor classes. However, mechano- and thermo-sensitive afferents interact at spinal and supraspinal levels. Yet, most studies on responses to cooling stimuli are confounded by mechanical contact, making these interactions difficult to isolate. Methods for precise control of non-mechanical thermal stimulations remain challenging, particularly in the cold range. NEW METHOD We developed a non-tactile, focal, temperature-controlled, multi-purpose cooling stimulator. This method controls the exposure of a target skin region to a dry-ice source. Using a thermal camera to monitor skin temperature, and adjusting the source-skin distance accordingly, we could deliver non-tactile cooling stimuli with customisable profiles, for studying different aspects of cold sensation. RESULTS To validate our method, we measured absolute and relative thresholds for cold sensation without mechanical contact in 13 human volunteer participants, using the method of limits. We found that the absolute cold detection threshold was 32.71 oC ± 0.88 oC. This corresponded to a threshold relative to each participant's baseline skin temperature of - 1.08 oC ± 0.37 oC. COMPARISONS WITH EXISTING METHOD Our method allows cooling stimulation without the confound of mechanical contact, in a controllable and focal manner. CONCLUSIONS We report a non-contact cooling stimulator and accompanying control system. We used this to measure cold thresholds in the absence of confounding touch. Our method enables more targeted studies of both cold sensory pathways, and of cold-touch interactions.
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Affiliation(s)
| | - Maansib Chowdhury
- Institute of Cognitive Neuroscience, University College London, London, UK
| | | | - Gian Domenico Iannetti
- Division of Biosciences, University College London, London, UK; Neuroscience and Behaviour Laboratory, Italian Institute of Technology, Rome, Italy
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK
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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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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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Seo Y, Kim JH. Differential Cutaneous Thermal Sensitivity in Humans: Method of Limit vs. Method of Sensation Magnitude. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312576. [PMID: 34886305 PMCID: PMC8657088 DOI: 10.3390/ijerph182312576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The method of limits (MLI) and method of level (MLE) are commonly employed for the quantitative assessment of cutaneous thermal sensitivity. Thermal sensation and thermal comfort are closely related and thermal sensations evoked from the peripheral thermoreceptors play an important role in thermoregulatory response to maintain normal body temperature. The purpose of this study was to compare the regional distribution of cutaneous warm and cold sensitivity between MLI and the method of sensation magnitude (MSM). METHOD Twenty healthy men completed MLI and MSM to compare the regional distribution of cutaneous warm and cold sensitivity in the thermal neutral condition. The subjects rested on a bed in a supine position for 20 min. Next, the cutaneous thermal sensitivity of ten body sites was assessed by the means of MLI and MSM for both warmth and cold stimuli. RESULTS The absolute mean heat flux in MLI and thermal sensation magnitude in MSM showed significantly greater sensitivity to cold than to warm stimulation (p < 0.01), together with a similar pattern of regional differences across ten body sites. Both sensory modalities indicated acceptable reliability (SRD%: 6.29-8.66) and excellent reproducibility (ICC: 0.826-0.906; p < 0.01). However, the Z-sore distribution in MSM was much narrower than in MLI, which may limit the test sensitivity for the detection of sensory disorders and/or comparison between individuals. CONCLUSION The present results showed that both MLI and MSM are effective means for evaluating regional cutaneous thermal sensitivity to innocuous warm and cold stimulations to a strong degree of reliability and reproducibility.
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Affiliation(s)
- Yongsuk Seo
- Sports AIX Graduate Program, Pohang University of Science and Technology, Pohang 37673, Korea;
| | - Jung-Hyun Kim
- Department of Sports Medicine, Kyung Hee University, Yongin-si 17104, Korea
- Correspondence:
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[Quantitative sensory testing for neuropathic pain and its relevance for physiotherapy]. Schmerz 2021; 36:437-446. [PMID: 34424391 DOI: 10.1007/s00482-021-00576-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neuropathic pain syndromes are typically characterized by high chronification rates as well as long and intensive pain episodes. Early and accurate diagnosis of neuropathic pain is a basic skill of physiotherapists and other medical professionals, may allow for appropriate medical treatment and help to prevent possible consequential damage. Quantitative sensory testing (QST) can be applied as a supplement to conventional neurological bedside testing in the evaluation of neuropathic pain. Over recent decades, QST has come to hold a significant position in the field of pain research. However, despite these developments, the application of QST in clinical practice has lagged behind. OBJECTIVES What is the value of QST in the study of neuropathic pain? Have the conditions for personal clinical use of the QST been established in physiotherapy practice? Have the pathways for specific implementation of the QST been defined? METHOD Literature research as part of a Bachelor thesis in Physiotherapy. RESULTS QST constitutes a valid examination tool that is able to evaluate the complete somatosensory profile. In this way, QST may provide substantial additional benefit in the examination of neuropathic pain patients compared to other conventional testing procedures, especially when it comes to small-fibre neuropathies. These small fibres seem to be particularly affected in asymptomatic patients as well as early phases of neuropathies and cannot be investigated via conventional testing procedures. This makes the use of partial aspects of the QST a proven instrument for physiotherapists and medical staff, which was particularly useful in the decision-making process for neuropathies. DISCUSSION Nonetheless, regarding the results, there are still several limiting factors that hamper the routine use of QST. Some of these can be resolved by precisely adhering to testing protocols and taking precautions. Other highly relevant issues for clinical practice, such as the immense cost of equipment and the excessive time required for testing, have not been satisfactorily overcome as yet. Less comprehensive testing protocols as well as the innovation of handy and cost-effective testing devices might offer initial approaches to enhance the widespread use of QST. Complementing conventional bedside testing by adding thermal discrimination tests and pain detection threshold tests might prove to be another possibility to integrate the benefit of QST into clinical practice. CONCLUSION QST makes a significant contribution to the investigation and diagnosis of neuropathies. Physiotherapists are encouraged to implement partial aspects of the QST in a standard examination in order to have a positive effect on both early detection and treatment.
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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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Hypothalamic-pituitary-adrenal axis, subjective, and thermal stress responses in midlife women with vasomotor symptoms. ACTA ACUST UNITED AC 2021; 28:439-443. [DOI: 10.1097/gme.0000000000001703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Neuropathy in sporadic inclusion body myositis: A multi-modality neurophysiological study. Clin Neurophysiol 2020; 131:2766-2776. [PMID: 32928695 DOI: 10.1016/j.clinph.2020.07.025] [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: 02/23/2020] [Revised: 07/09/2020] [Accepted: 07/22/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Sporadic inclusion body myositis (sIBM) has been associated with neuropathy. This study employs nerve excitability studies to re-examine this association and attempt to understand underlying pathophysiological mechanisms. METHODS Twenty patients with sIBM underwent median nerve motor and sensory excitability studies, clinical assessments, conventional nerve conduction testing (NCS) and quantitative thermal threshold studies. These results were compared to established normal controls, or results from a normal cohort of older control individuals. RESULTS Seven sIBM patients (35%) demonstrated abnormalities in conventional NCS, with ten patients (50%) demonstrating abnormalities in thermal thresholds. Median nerve motor and sensory excitability differed significantly in sIBM patients when compared to normal controls. None of these neurophysiological markers correlated significantly with clinical markers of sIBM severity. CONCLUSION A concurrent neuropathy exists in a significant proportion of sIBM patients, with nerve excitability studies revealing changes possibly consistent with axolemmal depolarization or concurrent neuronal adaptation to myopathy. Neuropathy in sIBM does not correlate with muscle disease severity and may reflect a differing tissue response to a common pathogenic factor. SIGNIFICANCE This study affirms the presence of a concurrent neuropathy in a large proportion of sIBM patients that appears independent of the severity of myopathy.
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Pouyau C, Grasland M, Leroux C, Chesnel C, Turmel N, Sheikh Ismael S, Le Breton F, Amarenco G, Hentzen C. Relationship between desire to void and bladder capacity and rectal sensory function in patients with multiple sclerosis and anorectal disorders. Neurourol Urodyn 2020; 39:1129-1136. [PMID: 32163639 DOI: 10.1002/nau.24330] [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: 11/01/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022]
Abstract
AIMS The primary aim of this study was to assess the relationship between a strong desire to void (SDV) and rectal sensory function in patients with multiple sclerosis (PwMS) and anorectal disorders. The secondary aim was to identify clinical, urodynamic or manometric factors associated with greater rectal sensory function impairment in this population. METHODS Thirty PwMS (mean age 49.2 ± 10.9 years) with anorectal disorders (constipation and/or fecal incontinence) participated in this observational study. Rectal sensory parameters during anorectal manometry were recorded at a strong desire to void and after urination (PV, post-void). The primary outcome was the desire to defecate volume. Secondary outcomes were first perception and maximum tolerated threshold volumes, presence and modulation of recto-anal inhibitory reflex. RESULTS The mean desire to defecate volume was 125 ± 59 mL at SDV and 104 ± 64 mL at PV (P < .001). The mean maximum tolerated volume was 167 ± 61 mL at SDV vs 141 ± 64 mL after urination (P = .01). The other parameters were not different between SVD and PV conditions. No predictive factors for greater impairment of rectal sensory function were identified. CONCLUSION This study suggests a relationship between bladder sensation and thus bladder capacity, and rectal sensory function in PwMS and with anorectal disorders.
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Affiliation(s)
- Camille Pouyau
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Matthieu Grasland
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Camille Leroux
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Camille Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Nicolas Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Samer Sheikh Ismael
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Frederique Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Claire Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
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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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Boland-Freitas R, Ng K. Assessment of small sensory fiber function in myotonic dystrophy type 1. Muscle Nerve 2019; 60:575-579. [PMID: 31443127 DOI: 10.1002/mus.26673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/14/2019] [Accepted: 08/18/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a multisystem disorder affecting the peripheral nervous system. However, studies evaluating somatic small fiber sensory nerve function, which may contribute to pain in DM1, are lacking. METHODS Using quantitative sensory testing of the hand and foot, we evaluated Aδ and C-fiber function. Of 20 adult DM1 patients recruited, 16 were analyzed. Their results were compared with those of 32 age- and sex-matched controls. RESULTS No DM1 patient had diabetes mellitus or clinical evidence of small fiber neuropathy. In DM1, hand (P < .01) and foot (P = 0.02) warm detection thresholds were higher than those of controls. Cool detection thresholds were lower in the foot (P < .001). CONCLUSIONS Subclinical small sensory fiber dysfunction occurs in DM1 patients without large fiber neuropathy. Further research with other modalities is required to characterize these disturbances as disease modifying therapies are developed.
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Affiliation(s)
- Robert Boland-Freitas
- Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Neurology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Karl Ng
- Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Sheen YJ, Li TC, Lin JL, Tsai WC, Kao CD, Bau CT, Sheu WHH. Association between thermal threshold abnormalities and peripheral artery disease in patients with type 2 diabetes. Medicine (Baltimore) 2018; 97:e13803. [PMID: 30572541 PMCID: PMC6319792 DOI: 10.1097/md.0000000000013803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Both diabetic peripheral neuropathy and peripheral arterial disease (PAD) cause foot ulcers and often result in non-traumatic amputations in patients with type 2 diabetes. This study aimed to evaluate the association between clinical variables, PAD, and subclinical diabetic small fiber peripheral neuropathy detected by abnormal thermal thresholds of the lower extremities in patients with type 2 diabetes.We investigated 725 consecutive patients with type 2 diabetes (male/female: 372/353; mean age, 67 ± 11 years) who did not have apparent cardiovascular disease (including coronary artery disease, arrhythmia, and stroke) and who underwent the quantitative sensory test for thermal (warm and cold) thresholds of the lower limbs and ankle-brachial index (ABI)/toe-brachial index (TBI) examinations in 2015. The analyses included glycated hemoglobin, estimated glomerular filtration rate, and other characteristics.In total, 539 (74.3%) patients showed an abnormality of at least 1 thermal threshold in their feet. All patients with an abnormal ABI (<0.9) had concurrent impaired thermal thresholds, and 93% (87/94) of patients with an abnormal TBI experienced abnormal thermal thresholds in the lower limbs. Age- and sex-adjusted TBI and estimated glomerular filtration rate were significantly correlated to abnormal thermal thresholds. In the multivariate analysis, fasting plasma glucose, and glycated hemoglobin were independently associated with abnormal thermal thresholds in the lower extremities.Subclinical thermal threshold abnormalities of the feet are significantly associated with PAD and nephropathy in patients who have type 2 diabetes without cardiovascular disease.
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Affiliation(s)
- Yi-Jing Sheen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taiwan
- Department of Public Health
| | - Tsai-Chung Li
- Department of Public Health
- Institute of Biostatistics, College of Public Health
| | - Jiann-Liang Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chuen-Der Kao
- Division of Neurology, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare
| | - Cho-Tsan Bau
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taiwan
| | - Wayne H.-H. Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei
- Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung
- School of Medicine, National Defense Medical Center, Taipei
- Rong Hsing Research Center For Translational Medicine, National Chung, Hsing University, Taichung, Taiwan
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16
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Takahashi M, Shinya A, Ito N, Ebina J, Abe K, Inaba A, Orimo S. Utility of thermographic measurements of laterality of body surface temperature to prevent misdiagnosis of acute Wallenberg's syndrome. Brain Behav 2018; 8:e01040. [PMID: 29993195 PMCID: PMC6085920 DOI: 10.1002/brb3.1040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Acute Wallenberg's syndrome (WS) is sometimes misdiagnosed as a nonstroke disease including auditory vertigo, and careful neurological examination is required for a precise diagnosis. Lateral difference of body surface temperature (BST) had been reported as a symptom of WS, although further details of this symptom are currently lacking. Our aim was to investigate the laterality of BST of patients with acute WS using thermography and the usefulness of thermography to detect acute WS. METHODS Nine consecutive patients with new-onset acute WS and nine patients with acute pontine infarction, intended for a comparison, were enrolled. Using thermography, the BST of patients was measured and initially evaluated visually. Detailed BSTs were measured using dedicated software. We examined the relationship between BST and other clinical factors, including first diagnosis, clinical symptoms, and MRI findings. RESULTS Four patients with WS (44.44%) were misdiagnosed with nonstroke disease and did not receive a thermography assessment at their first visit; in contrast, all acute pontine infarction patients were diagnosed with brain infarction. Eight patients with WS (89%) showed a laterality of BST at multiple sites, and three of eight patients showed a whole-body laterality of BST; in contrast, only two pontine infarction patients showed laterality of BST at one or two sites. These lateral BST differences were easily observed visually using thermography within two minutes. The BST laterality gradually decreased over time in almost all patients with WS. The infarction size in the WS patients with whole-body laterality of BST was craniocaudally larger than in the other patients, and the size was smallest in the patient showing no BST laterality. CONCLUSIONS In contrast to acute pontine infarction patients, almost all patients with acute WS showed lateral BST differences, which was easily detected with thermography. Thermography may thus be a useful tool to prevent misdiagnosis of acute WS.
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Affiliation(s)
| | - Akiko Shinya
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Naohito Ito
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Junya Ebina
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Keisuke Abe
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
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Method-of-limits; Cold and warm perception thresholds at proximal and distal body regions. Clin Neurophysiol Pract 2018; 3:134-140. [PMID: 30215024 PMCID: PMC6133911 DOI: 10.1016/j.cnp.2018.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 01/23/2023] Open
Abstract
High correlation between thermal thresholds and age at the dorsal foot. Reference values at eight different test sites. Reference values at various proximal and distal sites in the upper and lower extremities.
Objective Thermal quantitative sensory testing with the ‘Method-of-Limits’ is an established rationale for detection of small nerve fiber dysfunction, but adequate reference values are crucial for such evaluations, regardless of the underlying cause. This study assessed reference data for cold- (CPT) and warm- (WPT) perception thresholds at both proximal and distal sites in eight body regions of the lower and upper extremities, all determined within the same test session for each subject. Methods Seventy-five healthy subjects (aged 16–72 years) were tested according to the method-of-limit for CPT and WPT at the dorsum of the foot, the medial and lateral lower leg, the ventral thigh, the thenar eminence, the radial and ulnar part of the lower arm, and the anterior deltoid part of the upper arm. Results Overall, thermal perception thresholds (TPT) varied with test location, but were higher in the lower than in the upper part of the body, also WPT were generally higher than CPT. TPT at the dorsum foot highly correlated with age, while inconsistent correlations were noted between TPT and age or height at other tested locations. Conclusion This study describes for the first time reference values at eight defined body regions, at both proximal and distal sites. Significance The report enables refined evaluations of general small nerve fiber function, as assessed by quantitative thermal sensory testing with the Method-of-Limits.
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18
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Lundström R, Noor Baloch A, Hagberg M, Nilsson T, Gerhardsson L. Long-term effect of hand-arm vibration on thermotactile perception thresholds. J Occup Med Toxicol 2018; 13:19. [PMID: 29977321 PMCID: PMC6013850 DOI: 10.1186/s12995-018-0201-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022] Open
Abstract
Background Occupational exposure to hand-transmitted vibration (HTV) is known to cause neurological symptoms such as numbness, reduced manual dexterity, grip strength and sensory perception. The purpose of this longitudinal study was to compare thermotactile perception thresholds for cold (TPTC) and warmth (TPTW) among vibration exposed manual workers and unexposed white collar workers during a follow-up period of 16 years to elucidate if long-term vibration exposure is related to a change in TPT over time. Methods The study group consisted of male workers at a production workshop at which some of them were exposed to HTV. They were investigated in 1992 and followed-up in 2008. All participants were physically examined and performed TPT bilaterally at the middle and distal phalanges of the second finger. Two different vibration exposure dosages were calculated for each individual, i.e. the individual cumulative lifetime dose (mh/s2) or a lifetime 8-h equivalent daily exposure (m/s2). Results A significant mean threshold difference was found for all subjects of about 4-5 °C and 1-2 °C in TPTW and TPTC, respectively, between follow-up and baseline. No significant mean difference in TPTC between vibration exposed and non-exposed workers at each occasion could be stated to exist. For TPTW a small but significant difference was found for the right index finger only. Age was strongly related to thermotactile perception threshold. The 8-h equivalent exposure level (A (8)) dropped from about 1.3 m/s2 in 1992 to about 0.7 m/s2 in 2008. Conclusions A lifetime 8-h equivalent daily exposure to hand-transmitted vibration less than 1.3 m/s2 does not have a significant effect on thermotactile perception. Age, however, has a significant impact on the change of temperature perception thresholds why this covariate has to be considered when using TPT as a tool for health screening.
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Affiliation(s)
- Ronnie Lundström
- 1Department of Radiation Sciences, Umeå University, SE-901 87 Umeå, Sweden.,3Department of Occupational and Environmental Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Adnan Noor Baloch
- 2Department of Occupational and Environmental Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Hagberg
- 2Department of Occupational and Environmental Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tohr Nilsson
- 3Department of Occupational and Environmental Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Lars Gerhardsson
- 2Department of Occupational and Environmental Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Maher DP, Ding W, Singh S, Opalacz A, Fishman C, Houghton M, Ahmed S, Chen L, Mao J, Zhang Y. Thermal QST Phenotypes Associated with Response to Lumbar Epidural Steroid Injections: A Pilot Study. PAIN MEDICINE 2018; 18:1455-1463. [PMID: 28340251 DOI: 10.1093/pm/pnw364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective Response to lumbar epidural steroid injection in lumbar radicular pain varies. The purpose of this study is to characterize the changes in quantitative sensory testing (QST) phenotypes of subjects and compare the QST characteristics in patients who do respond to treatment of radicular pain with a lumbar epidural steroid injection (ESI). Design Prospective, observational pilot study. Setting Outpatient pain center. Methods Twenty subjects with a lower extremity (LE) radicular pain who were scheduled to have an ESI were recruited. At the visit prior to and four weeks following an ESI, subjects underwent QST measurements of both the affected LE and the contralateral unaffected UE. Results Following an ESI, nine subjects reported a greater than 30% reduction in radicular pain and 11 reported a less than 30% reduction in radicular pain. Subjects who had less than 30% pain reduction response (nonresponders) to an ESI had increased pre-injection warm sensation threshold (37.30 °C, SD = 2.51 vs 40.39, SD = 3.36, P = 0.03) and heat pain threshold (47.22 °C, SD = 1.38, vs 48.83 °C, SD = 2.10, P = 0.04). Further, the nonresponders also showed increased pre-injection warm sensation threshold as measured in the difference of warm sensation detection threshold difference in the affected limb and the unaffected arm (2.68 °C, SD = 2.92 vs 5.67 °C, SD = 3.22, P = 0.045). Other QST parameters were not affected. Conclusions The results show that the nonresponders to ESIs have increased detection threshold to heat pain and warm sensation, suggesting that a preexisting dysfunction in the C fibers in this group of subjects who can be detected by QST. Such altered QST characteristics may prognosticate the response to ESIs.
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Affiliation(s)
- Dermot P Maher
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Weihua Ding
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarabdeep Singh
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arissa Opalacz
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | - Claire Fishman
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Houghton
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Lucy Chen
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | - Jianren Mao
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | - Yi Zhang
- Division of Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Sharma S, Tobin V, Vas PRJ, Malik RA, Rayman G. The influence of age, anthropometric and metabolic variables on LDIFLARE and corneal confocal microscopy in healthy individuals. PLoS One 2018. [PMID: 29518115 PMCID: PMC5843248 DOI: 10.1371/journal.pone.0193452] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction The laser Doppler imaging (LDI) FLARE and corneal confocal microscopy (CCM) are reliable markers of small fibre function (SFF) and structure (SFS), respectively, but the impact of potential confounding variables needs to be defined. The objective of this study was to determine the influence of age, anthropometric and biochemical variables on LDI and CCM. Methods 80 healthy volunteers (43 males) (age: 39.7±15.2 yrs.) underwent LDIFLARE and CCM assessment and the effect of age, anthropometric and biochemical variables was determined using multivariate analysis. Results There was an age-related decline in LDIFLARE (0.07cm2/yr; R2 = 0.669; p = <0.0001) and CCM parameters (CNFD: 0.05 fibres/mm2 /yr; R2 = 0.590; p = <0.0001, CNBD: 0.06 branches/mm2/yr; R2 = 0.549; p = 0.001and CNFL 0.07 mm/mm2/yr; R2 = 0.369; p = 0.009). BMI did not influence SFF (p = 0.08) but had a significant independent association with CNFD (p = 0.01). Fasting triglycerides (TG) independently influenced the LDIFLARE (βc:-0.204; p = 0.008) and all CCM indices (βc:-0.191 to -0.243; p = <0.05). HbA1c was significantly associated with CNFD only (p = 0.001) but not with LDIFLARE, CNBD or CNFL (p = ≥0.05). Blood pressure and total cholesterol were not associated with LDIFLARE or any CCM parameters. There was a significant correlation between LDIFLARE and all CCM parameters (p = ≤0.01). Conclusions This study shows that in healthy controls, both SFF measured by LDIFLARE and SFS assessed by CCM showed a significant inverse correlation with age and triglycerides, perhaps suggesting the use of age-specific normative values when interpreting these outcomes. Furthermore, this study shows that in healthy controls, despite measuring different neural parameters, both methods correlated significantly with each other.
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Affiliation(s)
- Sanjeev Sharma
- Diabetes Research Unit, The Ipswich Hospital NHS Trust, Ipswich, United Kingdom
| | - Victoria Tobin
- Diabetes Research Unit, The Ipswich Hospital NHS Trust, Ipswich, United Kingdom
| | - Prashanth R. J. Vas
- Department of Diabetes, The Kings College NHS Foundation Trust, London, United Kingdom
| | - Rayaz A. Malik
- Weill Cornell Medicine-Qatar, Doha, Qatar & Institute of Cardiovascular Medicine, University of Manchester, Manchester, United Kingdom
| | - Gerry Rayman
- Diabetes Research Unit, The Ipswich Hospital NHS Trust, Ipswich, United Kingdom
- * E-mail:
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Burström L, Björ B, Nilsson T, Pettersson H, Rödin I, Wahlström J. Thermal perception thresholds among workers in a cold climate. Int Arch Occup Environ Health 2017; 90:645-652. [PMID: 28497276 PMCID: PMC5583265 DOI: 10.1007/s00420-017-1227-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Abstract
Purpose To investigate whether exposure to cold could influence the thermal perception thresholds in a working population. Methods This cross-sectional study was comprised of 251 males and females and was carried out at two mines in the northern part of Norway and Sweden. The testing included a baseline questionnaire, a clinical examination and measurements of thermal perception thresholds, on both hands, the index (Digit 2) and little (Digit 5) fingers, for heat and cold. Results The thermal perception thresholds were affected by age, gender and test site. The thresholds were impaired by experiences of frostbite in the fingers and the use of medication that potentially could affect neurosensory functions. No differences were found between the calculated normative values for these workers and those in other comparative investigations conducted in warmer climates. Conclusions The study provided no support for the hypothesis that living and working in cold climate will lead to impaired thermal perception thresholds. Exposure to cold that had caused localized damage in the form of frostbite was shown to lead to impaired thermal perception.
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Affiliation(s)
- Lage Burström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden. .,Arcum, Umeå University, Umeå, Sweden.
| | - Bodil Björ
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden.,Arcum, Umeå University, Umeå, Sweden
| | - Tohr Nilsson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden.,Arcum, Umeå University, Umeå, Sweden
| | - Hans Pettersson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden.,Arcum, Umeå University, Umeå, Sweden
| | - Ingemar Rödin
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway.,Swedish Work Environment Authority, Stockholm, Sweden
| | - Jens Wahlström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden.,Arcum, Umeå University, Umeå, Sweden
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22
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Ponirakis G, Odriozola MN, Odriozola S, Petropoulos IN, Azmi S, Ferdousi M, Fadavi H, Alam U, Marshall A, Jeziorska M, Miro A, Kheyami A, Tavakoli M, Al-Ahmar A, Odriozola MB, Odriozola A, Malik RA. NerveCheck for the Detection of Sensory Loss and Neuropathic Pain in Diabetes. Diabetes Technol Ther 2016; 18:800-805. [PMID: 27922760 PMCID: PMC5178001 DOI: 10.1089/dia.2016.0279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Accurate and economic detection of nerve damage in diabetes is key to more widespread diagnosis of patients with diabetic peripheral neuropathy (DPN) and painful diabetic neuropathy. This study examined the diagnostic performance of NerveCheck, an inexpensive ($500) quantitative sensory testing (QST) device. METHODS One hundred forty-four subjects (74 with and 70 without diabetes) underwent assessment with NerveCheck, neuropathy disability score (NDS), nerve conduction studies (NCS), intraepidermal and corneal nerve fiber density (IENFD and CNFD), and McGill questionnaire for neuropathic pain. RESULTS Of the 74 subjects with diabetes, 41 were diagnosed with DPN based on the NDS. The NerveCheck scores for vibration perception threshold (VPT), cold perception threshold (CPT), and warm perception threshold (WPT) were significantly lower (P ≤ 0.0001) in diabetic patients with DPN compared to patients without DPN. The diagnostic accuracy of VPT was high with reference to NCS (area under the curve [AUC]: 82%-84%) and moderate for IENFD, CNFD, and neuropathic pain (AUC: 60%-76%). The diagnostic accuracy of CPT and WPT was moderate with reference to NCS, IENFD, and CNFD (AUC: 69%-78%) and low for neuropathic pain (AUC: 63%-65%). CONCLUSIONS NerveCheck is a low-cost QST device with good diagnostic utility for identifying sensory deficits, comparable to established tests of large and small fiber neuropathy and for the severity of neuropathic pain.
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Affiliation(s)
- Georgios Ponirakis
- Research Division, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Maria N. Odriozola
- Department of Electronics Engineering, Phi Med Europe Barcelona, Barcelona, Spain
| | - Samantha Odriozola
- Department of Electronics Engineering, Phi Med Europe Barcelona, Barcelona, Spain
| | - Ioannis N. Petropoulos
- Research Division, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Shazli Azmi
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Maryam Ferdousi
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Hassan Fadavi
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Uazman Alam
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Andrew Marshall
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Maria Jeziorska
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Anthony Miro
- Department of Electronics Engineering, Phi Med Europe Barcelona, Barcelona, Spain
| | - Ahmad Kheyami
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Mitra Tavakoli
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ahmed Al-Ahmar
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Maria B. Odriozola
- Department of Electronics Engineering, Phi Med Europe Barcelona, Barcelona, Spain
| | - Ariel Odriozola
- ICEN, Catalonian Institute of Endocrinology and Nutrition, Medical Centre, Barcelona, Spain
| | - Rayaz A. Malik
- Research Division, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Boland-Freitas R, Coward S, Lofts A, Barnes EH, Ng K. Operator differences in thermal quantitative sensory testing. Clin Neurophysiol Pract 2016; 1:67-68. [PMID: 30214962 PMCID: PMC6123929 DOI: 10.1016/j.cnp.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- R Boland-Freitas
- Department of Neurology and Clinical Neurophysiology, Clinical Administration 3E, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
| | - S Coward
- Department of Neurology and Clinical Neurophysiology, Clinical Administration 3E, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
| | - A Lofts
- Department of Neurology and Clinical Neurophysiology, Clinical Administration 3E, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
| | - E H Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown 2050, NSW, Australia
| | - K Ng
- Department of Neurology and Clinical Neurophysiology, Clinical Administration 3E, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
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24
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Waller R, Smith AJ, O’Sullivan PB, Slater H, Sterling M, Alexandra McVeigh J, Straker LM. Pressure and cold pain threshold reference values in a large, young adult, pain-free population. Scand J Pain 2016; 13:114-122. [DOI: 10.1016/j.sjpain.2016.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 01/10/2023]
Abstract
Abstract
Background and aims
Currently there is a lack of large population studies that have investigated pain sensitivity distributions in healthy pain free people. The aims of this study were: (1) to provide sex-specific reference values of pressure and cold pain thresholds in young pain-free adults; (2) to examine the association of potential correlates of pain sensitivity with pain threshold values.
Methods
This study investigated sex specific pressure and cold pain threshold estimates for young pain free adults aged 21–24 years. A cross-sectional design was utilised using participants (n =617) from the Western Australian Pregnancy Cohort (Raine) Study at the 22-year follow-up. The association of site, sex, height, weight, smoking, health related quality oflife, psychological measures and activity with pain threshold values was examined. Pressure pain threshold (lumbar spine, tibialis anterior, neck and dorsal wrist) and cold pain threshold (dorsal wrist) were assessed using standardised quantitative sensory testing protocols.
Results
Reference values for pressure pain threshold (four body sites) stratified by sex and site, and cold pain threshold (dorsal wrist) stratified by sex are provided. Statistically significant, independent correlates of increased pressure pain sensitivity measures were site (neck, dorsal wrist), sex (female), higher waist-hip ratio and poorer mental health. Statistically significant, independent correlates of increased cold pain sensitivity measures were, sex (female), poorer mental health and smoking.
Conclusions
These data provide the most comprehensive and robust sex specific reference values for pressure pain threshold specific to four body sites and cold pain threshold at the dorsal wrist for young adults aged 21–24 years. Establishing normative values in this young age group is important given that the transition from adolescence to adulthood is a critical temporal period during which trajectories for persistent pain can be established.
Implications
These data will provide an important research resource to enable more accurate profiling and interpretation of pain sensitivity in clinical pain disorders in young adults. The robust and comprehensive data can assist interpretation of future clinical pain studies and provide further insight into the complex associations of pain sensitivity that can be used in future research.
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Affiliation(s)
- Robert Waller
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Anne Julia Smith
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Peter Bruce O’Sullivan
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury , Menzies Health Institute , Griffith University , QLD , 4222 , Australia
| | - Joanne Alexandra McVeigh
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Leon Melville Straker
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
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25
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Clough GF, McCormick KG, Scorletti E, Bhatia L, Calder PC, Griffin MJ, Byrne CD. Higher body fat percentage is associated with enhanced temperature perception in NAFLD: results from the randomised Wessex Evaluation of fatty Liver and Cardiovascular markers in NAFLD with OMacor thErapy trial (WELCOME) trial. Diabetologia 2016; 59:1422-1429. [PMID: 27106721 DOI: 10.1007/s00125-016-3966-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/01/2016] [Indexed: 01/18/2023]
Abstract
AIMS/HYPOTHESIS The effect of n-3 fatty acid treatment on temperature perception as a sensory nerve function modality is uncertain. In patients with non-alcoholic fatty liver disease (NAFLD) both with and without type 2 diabetes, we: (1) tested whether 15-18 months' treatment with 4 g/day of docosahexaenoic plus eicosapentaenoic acid (DHA+EPA) improved hot (HPT) and cold (CPT) temperature perception thresholds and (2) explored factors associated with HPT and CPT, in a randomised, double-blind, placebo-controlled trial. METHODS The effect of treatment (n = 44) on HPT, CPT and temperature perception index (TPI: difference between HPT and CPT) was measured at the big toe in 90 individuals without neuropathy (type 2 diabetes; n = 30). Participants were randomised 1:1, using sequential numbering, by personnel independent from the trial team. All participants and all members of the research team were blinded to group assignment. Data were collected in the Southampton National Institute for Health Research Biomedical Research Centre. Treatment effects and the independence of associations were testing by regression modelling. RESULTS Mean ± SD age was 50.9 ± 10.6 years. In men (n = 53) and women (n = 37), HPTs (°C) were 46.1 ± 5.1 and 43.1 ± 6.4 (p = 0.02), CPTs (°C) were 22.7 ± 3.4 and 24.5 ± 3.6 (p = 0.07) and TPIs (°C) were 23.4 ± 7.4 and 18.7 ± 9.5 (p = 0.008), respectively. In univariate analyses, total body fat percentage (measured by dual-energy x-ray absorptiometry [DXA]) was associated with HPT (r = -0.36 p = 0.001), CPT (r = 0.35 p = 0.001) and TPI (r = 0.39 p = 0.0001). In multivariable-adjusted regression models, adjusting for age, sex and other potential confounders, only body fat percentage was independently associated with HPT, CPT or TPI (p = 0.006, p = 0.006 and p = 0.002, respectively). DHA+EPA treatment did not modify HPT, CPT or TPI (p = 0.93, p = 0.44 and p = 0.67, respectively). There were no important adverse effects or side effects reported. CONCLUSIONS/INTERPRETATION Higher body fat percentage is associated with enhanced temperature perception. There was no benefit of treatment with high-dose n-3 fatty acids on the thresholds to detect hot or cold stimuli. TRIAL REGISTRATION ClinicalTrials.gov NCT00760513 FUNDING: This work was supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Unit grant and by a Diabetes UK allied health research training fellowship awarded to KMcC (Diabetes UK. BDA 09/0003937).
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Affiliation(s)
- Geraldine F Clough
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS), MP887, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Keith G McCormick
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS), MP887, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Eleonora Scorletti
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS), MP887, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lokpal Bhatia
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS), MP887, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS), MP887, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael J Griffin
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Christopher D Byrne
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS), MP887, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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26
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Tracy LM, Georgiou-Karistianis N, Gibson SJ, Giummarra MJ. Location, location, location: Variation in sensitivity to pain across the body. Eur J Pain 2016; 20:1721-1729. [PMID: 27221216 DOI: 10.1002/ejp.895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is evidence that sensitivity to noxious stimuli differs between the sexes and across the body, but few studies have investigated differences in the perception and experience of acute pain stimuli across the body in healthy individuals. METHODS We recruited 52 healthy participants, aged 18-36 (50% men) and administered 39, 42 and 45 °C stimuli at four body sites bilaterally to examine differences in the experience of pain intensity and unpleasantness between body sites via an 11-point numerical rating scale. RESULTS Noxious and innocuous thermal heat stimuli were perceived as significantly more intense when delivered to the wrist (M = 3.98, SD = 1.93) and back (M = 4.07, SD = 1.98) compared to the shoulder (M = 3.45, SD = 1.91) and leg (M = 3.46, SD = 1.87). Pain unpleasantness ratings yielded similar findings; stimuli were perceived as more unpleasant when administered to the wrist (M = 2.83, SD = 1.93) and lower back (M = 3.04, SD = 2.11) compared to the shoulder (M = 2.63, SD = 1.85) and leg (M = 2.26, SD = 1.82). CONCLUSIONS These findings suggest that painful thermal stimuli delivered to the wrist and back are perceived as more intense and unpleasant compared with other body sites in healthy persons. These differences may be due to variations in receptor density, or the relative importance of these sites for daily living and survival. SIGNIFICANCE Moreover, these insights are helpful for the design of studies investigating pain experience in healthy persons in experimental or clinical settings. WHAT DOES THIS STUDY ADD?: We tested sensitivity to acute suprathreshold thermal stimulations across a range of body sites to investigate for potential variability. We found significant differences in the perceived intensity and unpleasantness of noxious and innocuous thermal stimuli at the wrist and lower back, compared with the shoulder and leg. These results suggest that pain experience is driven by receptor density or the relative functional importance of these sites.
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Affiliation(s)
- L M Tracy
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia.
- Caulfield Pain Management and Research Centre, Caulfield, Australia.
| | - N Georgiou-Karistianis
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia
| | - S J Gibson
- Caulfield Pain Management and Research Centre, Caulfield, Australia
- National Aging Research Institute, Parkville, Australia
| | - M J Giummarra
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia
- Caulfield Pain Management and Research Centre, Caulfield, Australia
- School of Public Health & Preventative Medicine, Monash University, Clayton, Australia
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27
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Ponirakis G, Odriozola MN, Odriozola S, Petropoulos IN, Azmi S, Fadavi H, Alam U, Asghar O, Marshall A, Miro A, Kheyami A, Al-Ahmar A, Odriozola MB, Odriozola A, Malik RA. NerveCheck: An inexpensive quantitative sensory testing device for patients with diabetic neuropathy. Diabetes Res Clin Pract 2016; 113:101-7. [PMID: 26830855 PMCID: PMC5303576 DOI: 10.1016/j.diabres.2015.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/15/2015] [Accepted: 12/27/2015] [Indexed: 01/04/2023]
Abstract
AIMS Sensory neuropathy is central to the development of painful neuropathy, and foot ulceration in patients with diabetes. Currently, available QST devices take considerable time to perform and are expensive. NerveCheck is the first inexpensive ($500), portable QST device to perform both vibration and thermal testing and hence evaluate diabetic peripheral neuropathy (DPN). This study was undertaken to establish the reproducibility and diagnostic validity of NerveCheck for detecting neuropathy. METHODS 130 subjects (28 with DPN, 46 without DPN and 56 control subjects) underwent QST assessment with NerveCheck; vibration perception and thermal testing. DPN was defined according to the Toronto criteria. RESULTS NerveCheck's intra correlation coefficient for vibration, cold and warm sensation testing was 0.79 (95% LOA: -4.20 to 6.60), 0.86 (95% LOA: -1.38 to 2.72) and 0.71 (95% LOA: -2.36 to 3.83), respectively. The diagnostic accuracy (AUC) for vibration, cold and warm sensation testing was 86% (SE: 0.038, 95% CI 0.79-0.94), 79% (SE: 0.058, 95% CI 0.68-0.91) and 72% (SE: 0.058, 95% CI 0.60-0.83), respectively. CONCLUSIONS This study shows that NerveCheck has good reproducibility and comparable diagnostic accuracy to established QST equipment for the diagnosis of DPN.
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Affiliation(s)
- G Ponirakis
- Weill Cornell Medical College in Qatar, Research Division, Qatar Foundation, Education City, PO. Box 24144, Doha, Qatar; Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - M N Odriozola
- Phi Med Europe Barcelona, Department of Electronics Engineering, Barcelona, Spain
| | - S Odriozola
- Phi Med Europe Barcelona, Department of Electronics Engineering, Barcelona, Spain
| | - I N Petropoulos
- Weill Cornell Medical College in Qatar, Research Division, Qatar Foundation, Education City, PO. Box 24144, Doha, Qatar; Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - S Azmi
- Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - H Fadavi
- Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - U Alam
- Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - O Asghar
- Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - A Marshall
- Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - A Miro
- Phi Med Europe Barcelona, Department of Electronics Engineering, Barcelona, Spain
| | - A Kheyami
- Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - A Al-Ahmar
- Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK
| | - M B Odriozola
- Phi Med Europe Barcelona, Department of Electronics Engineering, Barcelona, Spain
| | - A Odriozola
- ICEN, Catalonian Institute of Endocrinology and Nutrition, Medical Centre, Barcelona, Spain; Endocrinology Department, Hospital Clinic Universitario de Barcelona, Spain
| | - R A Malik
- Weill Cornell Medical College in Qatar, Research Division, Qatar Foundation, Education City, PO. Box 24144, Doha, Qatar; Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
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28
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Abstract
Quantitative sensory testing (QST), a set of noninvasive methods used to assess sensory and pain perception, has been used for three decades. The precision of the instruments and the uninvasiveness encouraged many QST-based trials. The developments made have benefited multiple disciplines. QST relies on analysis of an individual's response to external stimuli, reflecting the integrity of the PNS and the sensory pathway. The sensory pathway cannot be assessed in isolation from the affective and cognitive characteristics of patients or testers. Many variables potentially affect the reliability and reproducibility of QST, which after all, is designed for the testing of individuals by other individuals. Several decades of QST research have yielded exciting contributions, but the future of QST cannot be fully known.
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Affiliation(s)
- Carlos J Roldan
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Emergency Medicine Memorial Hermann Hospital, Houston, TX 77030, USA
- Department of Emergency Medicine Lyndon B Johnson Hospital, Houston, TX 77026, USA
| | - Salahadin Abdi
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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