Laser-evoked potentials mediated by mechano-insensitive nociceptors in human skin.

Abstract

Laser-evoked potentials (LEP) were assessed after peripheral nerve block of the lateral femoral cutaneous nerve (LFCN) in healthy volunteers from partially anesthetized skin areas to differentially stimulate mechano-insensitive nociceptors. An ultrasound-guided nerve block of the LFCN was performed in 12 healthy male subjects with Ropivacain 1%. After 30min, the nerve block induced significantly larger anesthetic areas to mechanical stimuli than to electrical stimuli revealing an area of differential sensitivity. LEPs, reaction times and pain ratings were recorded in response to the laser stimuli of (1) completely anesthetic skin, (2) mechano-insensitive, but electrically excitable skin ('differential sensitivity'), (3) normal skin. LEP latencies in the area of differential sensitivity were increased compared to unaffected skin (228±8.5ms, vs. 181±3.6ms, p<0.01) and LEP amplitudes were reduced (14.8±1.2μV vs. 24.6±1.7μV, p<0.01). Correspondingly, psychophysically assessed response latencies in the differentially anesthetic skin were increased (649ms vs. 427ms, p<0.01) and pain ratings reduced (1.5/10 vs. 5/10 NRS, p<0.01). The increase in LEP latency suggests that mechano-insensitive heat-sensitive Aδ nociceptors (MIA, type II) have a slower conduction velocity or higher utilization time than mechano-sensitive type II Aδ nociceptors. Moreover, widely branched, slowly conducting and mechano-insensitive branches of Aδ nociceptors can explain our finding. LEPs in the differentially anesthetized skin provide specific information about a mechanically insensitive but heat-sensitive subpopulation of Aδ nociceptors. These findings support the concept thatA-fibre nociceptors exhibit a similar degree of modality specificity as C-fibre nociceptors.