title: Autonomic impairment in painful neuropathy.
abstract: OBJECTIVE
  1) To determine the degree and distribution and quantitate the severity of autonomic impairment in painful neuropathy (PN). 2) To assess the role of autonomic testing in evaluating PN.
  
  
  METHODS
  The authors studied 92 patients with PN (60 women and 32 men, age 56.9 +/- 12.4 years) using: 1) autonomic reflex testing (ART), Quantitative Sudomotor Axon Reflex Test (QSART), cardiac-vagal, head-up tilt, and surface skin temperature; 2) autonomic symptoms questionnaire; 3) nerve conduction (NCS) and laboratory studies; 4) quantitative sensory testing; 5) skin biopsy; and 6) Composite Autonomic Symptoms Score (CASS) scale to grade ART results from 0 (normal) to 10 (autonomic failure).
  
  
  RESULTS
  Autonomic involvement in PN had characteristic features. Main symptoms were pain, secretory and skin vasomotor signs, hypertension, and impotence. ART results were abnormal in 86 (93.5%) (CASS < 4), QSART in 67 (72.8%), cardiac-vagal index in 58 (63%), skin temperature in 51 (55.4%), orthostatic hypertension in 39 (42.3%), and family history of PN in 26 (21%) of patients. Group 1 (abnormal NCS) (n = 45) had more severe ART and sensory abnormalities than the Group 2 (normal NCS) (n = 47): 1) CASS 2.0 +/- 0.96 vs 1.55 +/- 0.88 (p < 0.01), cardiac-vagal index (p < 0.02), skin temperature (p < 0.02), hypertension (p < 0.03), cooling (p < 0.002), and vibration (p < 0.0005) thresholds.
  
  
  CONCLUSIONS
  Autonomic symptoms in painful neuropathy are predominantly cholinergic and form a unique constellation of features that are distinct from other autonomic neuropathies.
authors: Department of Neurology, The Ohio State University, Columbus, OH 43210, USA. novak.91@osu.edu
authors: V
authors: V
authors: Novak
authors: M L
authors: ML
authors: Freimer
authors: J T
authors: JT
authors: Kissel
authors: Z
authors: Z
authors: Sahenk
authors: I M
authors: IM
authors: Periquet
authors: S M
authors: SM
authors: Nash
authors: M P
authors: MP
authors: Collins
authors: J R
authors: JR
authors: Mendell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001341:Autonomic Nervous System / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D012044:Regression Analysis; D012684:Sensory Thresholds / Q000502:physiology; D011795:Surveys and Questionnaires