Impact of endovascular intervention on pain and sensory thresholds in nondiabetic patients with intermittent claudication: a pilot study.
Pain and sensory neuropathy are common in patients with peripheral arterial disease. So far it is unknown to what extent pain and sensory parameters can be ameliorated by endovascular intervention used to resolve the arterial obstruction. Seventeen nondiabetic patients with intermittent claudication were investigated in the present study. The patients had to undergo percutaneous transluminal angioplasty (PTA) to improve blood flow in the affected leg. To acquire detailed information of their sensory state quantitative sensory testing (QST) was performed before and 24 hours and 3 months after PTA. QST is a standardized clinical testing procedure for the detection of sensory changes that consists of multiple tests for thermal and mechanical detection and pain thresholds as well as vibratory thresholds and stimulus response functions. An age-matched control group was investigated with an interval of 3 months. Pain during exercise decreased by 60% (examined by numerical rating scale) after endovascular intervention, whereas the ankle/brachial-index-representing the peripheral hemodynamic situation-increased by 29%. Sensory function determined by QST did not change significantly following PTA over a 3-month period. Successfully performed PTA is highly effective in reducing exercise induced pain in patients with intermittent claudication.


CONCLUSIONS
The study demonstrates that successfully performed PTA is a highly effective tool in reducing exercise induced pain in patients with intermittent claudication. However, the pain reduction observed cannot be verified by evaluating sensory functions using standardized quantitative sensory testing.
Lang
Philip M
PM
Department of Anesthesiology, Interdisciplinary Pain Center, University of Munich, Germany. Philip.lang@med.uni-muenchen.de
Vock
Gesa
G
Schober
Gabriel M
GM
Kramer
Sybille
S
Abahji
Thomas
T
Crispin
Alexander
A
Irnich
Dominik
D
Hoffmann
Ulrich
U
D000800:Angioplasty, Balloon / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007511:Ischemia / Q000628:therapy; D007866:Leg / Q000098:blood supply / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000523:psychology*; D010865:Pilot Projects; D016896:Treatment Outcome