title: Sensory signs in complex regional pain syndrome and peripheral nerve injury.
abstract: This study determined patterns of sensory signs in complex regional pain syndrome (CRPS) type I and II and peripheral nerve injury (PNI). Patients with upper-limb CRPS-I (n=298), CRPS-II (n=46), and PNI (n=72) were examined with quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain. The majority of patients (66%-69%) exhibited a combination of sensory loss and gain. Patients with CRPS-I had more sensory gain (heat and pressure pain) and less sensory loss than patients with PNI (thermal and mechanical detection, hypoalgesia to heat or pinprick). CRPS-II patients shared features of CRPS-I and PNI. CRPS-I and CRPS-II had almost identical somatosensory profiles, with the exception of a stronger loss of mechanical detection in CRPS-II. In CRPS-I and -II, cold hyperalgesia/allodynia (28%-31%) and dynamic mechanical allodynia (24%-28%) were less frequent than heat or pressure hyperalgesia (36%-44%, 67%-73%), and mechanical hypoesthesia (31%-55%) was more frequent than thermal hypoesthesia (30%-44%). About 82% of PNI patients had at least one type of sensory gain. QST demonstrates more sensory loss in CRPS-I than hitherto considered, suggesting either minimal nerve injury or central inhibition. Sensory profiles suggest that CRPS-I and CRPS-II may represent one disease continuum. However, in contrast to recent suggestions, small fiber deficits were less frequent than large fiber deficits. Sensory gain is highly prevalent in PNI, indicating a better similarity of animal models to human patients than previously thought. These sensory profiles should help prioritize approaches for translation between animal and human research.
authors.affiliation: Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany Department of Pain Management, BG Universitätsklinikum Bergmansheil, Ruhr-University Bochum, Bochum, Germany Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Chair of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Germany Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany Department of Anaesthesiology, Ludwig-Maximilians-Universität München, Munich, Germany Department of Neurology, University of Erlangen-Nuremberg, Germany.
authors.forename: Janne
authors.initials: J
authors.lastname: Gierthmühlen
authors.forename: Christoph
authors.initials: C
authors.lastname: Maier
authors.forename: Ralf
authors.initials: R
authors.lastname: Baron
authors.forename: Thomas
authors.initials: T
authors.lastname: Tölle
authors.forename: Rolf-Detlef
authors.initials: RD
authors.lastname: Treede
authors.forename: Niels
authors.initials: N
authors.lastname: Birbaumer
authors.forename: Volker
authors.initials: V
authors.lastname: Huge
authors.forename: Jana
authors.initials: J
authors.lastname: Koroschetz
authors.forename: Elena K
authors.initials: EK
authors.lastname: Krumova
authors.forename: Meike
authors.initials: M
authors.lastname: Lauchart
authors.forename: Christian
authors.initials: C
authors.lastname: Maihöfner
authors.forename: Helmut
authors.initials: H
authors.lastname: Richter
authors.forename: Andrea
authors.initials: A
authors.lastname: Westermann
mesh_terms: D000328:Adult; D000368:Aged; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D016208:Databases, Factual; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000175:diagnosis* / Q000503:physiopathology