Sensory signs in complex regional pain syndrome and peripheral nerve injury

Janne Gierthmühlen, Christoph Maier, Ralf Baron, Thomas Tölle, Rolf Detlef Treede, Niels Birbaumer, Volker Huge, Jana Koroschetz, Elena K. Krumova, Meike Lauchart, Christian Maihöfner, Helmut Richter, Andrea Westermann

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)765-774
Number of pages10
JournalPain
Volume153
Issue number4
DOIs
Publication statusPublished - Apr 2012

Keywords

  • Complex regional pain syndrome
  • CRPS
  • Pain
  • Peripheral nerve injury
  • Quantitative sensory testing
  • Somatosensory

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Neurology
  • Pharmacology

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