Painful hand and moving finger treated by wearing a glove

Tactile stimulation programs in patients with hand dysesthesia after a peripheral nerve injury: A systematic review

STUDY DESIGN

This is a systematic review performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.

INTRODUCTION

Diverse approaches based on tactile stimulation are used in hand rehabilitation settings to treat touch-evoked dysesthesias. However, there is a lack of literature synthesis on the description and the effectiveness of the various approaches based on tactile stimulation that can be used for treating hand dysesthesia after nerve injury.

PURPOSE OF THE STUDY

The purpose of the study was to summarize the current evidence on tactile stimulation programs for managing touch-evoked hand dysesthesia due to nerve injury.

METHODS

The search was carried out on Medline, Embase, CINAHL, and the Cochrane Library databases. The selected studies had to present patients with touch-evoked dysesthesia after nerve injury who were treated with tactile stimulation approaches to reduce pain. The methodological quality of the included studies was assessed using the methodological index for nonrandomized studies scale, as well as the risk of bias.

RESULTS

Eleven studies met the inclusion criteria. These studies present tactile stimulation interventions that are heterogeneous relative to the target populations and the intervention itself (desensitization versus somatosensory rehabilitation method). Painful symptoms appear to diminish in patients with touch-evoked hand dysesthesia, regardless of the tactile stimulation program used. However, the included studies present significant risks of bias that limit the confidence in these results.

DISCUSSION

The evidence does not unequivocally support the beneficial effects of tactile stimulation to treat touch-evoked hand dysesthesia.

CONCLUSION

Future studies with more rigorous methodological designs, such as randomized controlled trials, are required to verify the potential benefits of these approaches.

Spinal-generated movement disorders: a clinical review

Spinal-generated movement disorders (SGMDs) include spinal segmental myoclonus, propriospinal myoclonus, orthostatic tremor, secondary paroxysmal dyskinesias, stiff person syndrome and its variants, movements in brain death, and painful legs-moving toes syndrome. In this paper, we review the relevant anatomy and physiology of SGMDs, characterize and demonstrate their clinical features, and present a practical approach to the diagnosis and management of these unusual disorders.

Painful legs and moving toes

The syndrome of painful legs-moving toes (PLMT) is an adult-onset, rare disorder characterized by pain, typically of a neuropathic quality, in the feet or legs, associated with writhing movements of one or more toes. It is the pain which usually brings the patient to medical attention. The syndrome may be unilateral or bilateral. Identical toe movements may occur without pain, referred to as: "painless legs-moving toes," and a similar condition affects the upper limbs: "painful arms-moving fingers." The pathophysiology of PLMT and its variants is not known but most reports suggest an association with a peripheral lesion, usually at the level of the root or nerve, though in many cases no cause is found. It has been suggested that a peripheral lesion causes aberrant input leading to "central reorganization," probably at the level of the spinal cord, and that the latter is responsible for the pain and movement. Treatment is often unsatisfactory and many drugs commonly used for neuropathic pain have been reported anecdotally to help (e.g., gabapentin). Other anecdotal therapies include spinal blocks, spinal cord stimulation, and local injection of botulinum toxin.

Painful limbs/moving extremities

Painful limbs/moving extremities (PLME) is a disorder characterized by spontaneous, complex, slow (1-2 Hz) involuntary toe or finger movements. The movements that can be bilateral or unilateral are usually accompanied by pain in the affected limbs. Painless variants are less common. PLME has been associated with peripheral and central nervous system disease although idiopathic cases have been reported. Its etiopathogenesis is unknown and treatment approaches remain largely empirical. Nerve blocks and botulinum toxin type A injections as well as oral medication have had some measure of success. Current theories suggest that central oscillator(s) at the spinal or supraspinal levels may be involved. Future research in PLME should include prospective electrophysiological and functional imaging studies as well as clinical trials with botulinum toxin injections and oral pharmacological agents.