title: Cold intolerance in surgically treated neuroma patients: a prospective follow-up study.
abstract: OBJECTIVE
  Cold intolerance may impose great changes on patients' lifestyle, work, and leisure activities, and it is often severely disabling. This study aims to investigate the prevalence and severity of cold intolerance in patients with injury-related neuromas of the upper extremity and improvement of symptoms after surgical treatment. Furthermore, we try to find predictors for cold intolerance and correlations with other symptoms.
  
  
  METHODS
  Between January 2006 and February 2009, 34 consecutive patients with surgically treated neuroma-specific neuropathic pain of the upper extremities were sent a questionnaire composed of general questions concerning epidemiologic variables and several specific validated questionnaires, including the Visual Analog Scale for pain. To estimate the prevalence of cold intolerance objectively in neuroma patients, we used the validated CISS (Cold Intolerance Symptom Severity) questionnaire with a prespecified cutoff point.
  
  
  RESULTS
  The CISS questionnaire was filled out by 33 patients before and 30 after surgery for neuroma-specific neuropathic pain, with a mean follow-up time of 24 months. We found a prevalence of cold intolerance of 91% before surgery, with a mean CISS score above the cutoff point for abnormal cold intolerance. After surgery, the prevalence of cold intolerance and the mean CISS score were not significantly different, whereas the mean Visual Analog Scale score decreased significantly (p < .01). CISS scores were lower in patients with neuromas associated with sharp injury of the peripheral nerve (p = .02). A higher VAS score correlated significantly with a higher CISS score (p = .01).
  
  
  CONCLUSIONS
  Cold intolerance is a difficult and persistent problem that has a high prevalence in patients with a painful injury-related neuroma. There seems to be a relationship between severity of cold intolerance as measured by CISS, pain as measured by the Visual Analog Scale, and type of injury. Cold intolerance may not disappear with time or surgical treatment.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Stokvis
authors.forename: Aleid C J
authors.initials: AC
authors.lastname: Ruijs
authors.forename: Johan W
authors.initials: JW
authors.lastname: van Neck
authors.forename: J Henk
authors.initials: JH
authors.lastname: Coert
mesh_terms: D000328:Adult; D003080:Cold Temperature / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009437:Neuralgia / Q000209:etiology; D009463:Neuroma / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D010147:Pain Measurement; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D011795:Surveys and Questionnaires; D034941:Upper Extremity / Q000293:injuries* / Q000294:innervation