Thermal Pain in Complex Regional Pain Syndrome Type I

Abstract

Background: Quantitative sensory testing (QST), with thermal threshold determinations, is a routine part of the comprehensive clinical workup of patients suffering from chronic pain, especially those with Complex Regional Pain Syndrome seen at our outpatient pain clinic. This is done to quantitatively assess each patient’s small fiber and sensory function in a controlled manner. Most patients have normal sensory detection thresholds, but there are large differences in thermal pain thresholds. Some patients display no thermal hyperalgesia, while other patients display severe thermal hyperalgesia when tested in all 4 limbs. Objectives: To ascertain the prevalence of thermal hyperalgesia in patients with complex regional pain syndrome type 1 (CRPS-I). Study Design: This was a retrospective review of the results of QST performed on 105 patients as part of their clinical workup. Setting: The outpatient clinic of the Department of Neurology at Drexel University College of Medicine. Methods: All patients had a diagnosis of CRPS-I. Thermal quantitative sensory testing, including cool detection, warm detection, cold pain, and heat pain, was performed on 8 distal sites on each patient as part of a comprehensive clinical examination. Results: With regards to thermal hyperalgesia, patients with CPRS-I appear to fall into distinct groups. One subgroup displays evidence of generalized cold and heat hyperalgesia, one subgroup displays evidence of generalized cold hyperalgesia only, one displays evidence of heat hyperalgesia only, and one subgroup does not display evidence of cold or heat hyperalgesia. Limitations: This study is based on retrospective information on a relatively small (105 patient records) number of patients. Since only patients with CRPS-I were included, the results are only applicable to this group. Conclusions: Thermal QST provides useful information about the sensory phenotype of individual patients. Subgrouping based on thermal hyperalgesia may be useful for future studies regarding prognosis, treatment selection, and efficacy. Key words: Complex regional pain syndrome, CRPS, quantitative sensory testing, QST, cold pain, heat pain, thermal hyperalgesia