title: Unexplainable nondermatomal somatosensory deficits in patients with chronic nonmalignant pain in the context of litigation/compensation: a role for involvement of central factors?
abstract: OBJECTIVE
  To address the prevalence and characteristics of nondermatomal somatosensory deficits (NDSD) in subjects with chronic pain in the context of compensation/litigation.
  
  
  METHODS
  Data were collected via standardized history, examination, and patient- as well as physician-drawn body maps in a consecutive series of 194 subjects seen for the purpose of an independent medical examination.
  
  
  RESULTS
  Forty-nine subjects (25.3%) with primarily widespread pain (often diagnosed as fibromyalgia) presented with hemisensory or quadrotomal deficits to pinprick and other cutaneous stimuli on the side of lateralized pain or worse pain. The NDSD limbs often had impairment of vibration sense (not infrequently associated with "forehead vibration split"), reduced strength, dexterity or movement, and extreme sensitivity to superficial skin palpation or profound insensitivity to deep pain. Spatial, temporal, qualitative, and evolutionary patterns of NDSD emerged associated with cognitive/affective symptoms. NDSD subjects were more often born outside Canada, more likely to be injured at work, present with abnormal pain behavior, and have negative investigations.
  
  
  CONCLUSIONS
  NDSD are a prevalent problem associated with chronic pain. Future research should explore the prevalence of NDSD in other pain populations, the role of personality and related factors, and the underlying biological substrate of these deficits.
authors.affiliation: Comprehensive Pain Program, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Mailis
authors.forename: M
authors.initials: M
authors.lastname: Papagapiou
authors.forename: M
authors.initials: M
authors.lastname: Umana
authors.forename: T
authors.initials: T
authors.lastname: Cohodarevic
authors.forename: J
authors.initials: J
authors.lastname: Nowak
authors.forename: K
authors.initials: K
authors.lastname: Nicholson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000453:epidemiology*; D016365:Liability, Legal; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D020886:Somatosensory Disorders / Q000175:diagnosis / Q000453:epidemiology; D014732:Vibration; D014942:Workers' Compensation / Q000331:legislation & jurisprudence*