Vibration Detection Threshold Research Articles

Does inflammation explain the link between multiple sensory impairment and dementia?

AbstractBackgroundMultiple sensory impairments are associated with increased risk of dementia, but the underlying mechanisms are unclear. One potential explanation is that the association is due to shared risk factors such as inflammation. Our objective was to evaluate whether multisensory impairment was associated with markers of inflammation (interleukin‐6, and C‐Reactive Protein (CRP) independent of other health conditions and test whether inflammation might explain the association between multisensory impairments and dementia risk.MethodWe studied 1,794 black and white older adults from the Health, Aging, and Body Composition Study, a prospective cohort study of older adults who were aged 70‐79 and dementia‐free at enrollment. Sensory abilities were assessed at study years 3‐5, vision was measured by log contrast sensitivity, hearing by pure tone average at 500, 1,000, 2,000, and 4,000 Hz; smell by the 12‐item Cross Cultural Smell Identification Test; and touch by vibration detection threshold of the big toe. A multisensory score (0‐12) was calculated based on sample quartiles and summed across each sensory domain. Interleukin‐6, and CRP were assayed based on blood sample near baseline and log transformed. Incident dementia over follow‐up was determined based on a combination of hospitalization records, dementia medications, or clinically significant cognitive decline. Using regression models, we investigated the associations between inflammation biomarkers, multisensory impairment, and dementia with adjustment for demographics, health conditions, and health behaviors.ResultBoth measures of inflammation were associated with higher multisensory impairment scores. 1‐log interleukin‐6 was associated with 0.25 points worse multisensory score (95%CI: 0.10, 0.40; p>0.001), 1‐log CRP levels was associated with 0.11 points worse multisensory score (95%CI: 0.01, 0.20; p=0.02). Higher level of interleukin‐6 (HR = 1.18; 95% CI: 1.02, 1.37; p=0.03) but not CRP (p=0.84) was associated increased dementia risk. In adjusted models, a 1‐point increase in the multisensory score was associated with a 14% higher risk of dementia (95% CI: 1.08; 1.20), estimates were similar even after including interleukin‐6 as an explanatory variable.ConclusionInflammation was independently associated with worse multisensory impairment scores. Although inflammation is also associated with dementia, it did not explain the association between multisensory impairment and dementia.

Potential differences in somatosensory function during premenopause and early and late postmenopause in patients with burning mouth syndrome: An observational case–control study

Background/purposeBurning mouth syndrome (BMS) is a chronic condition presenting as intraoral burning or dysesthesia, with a high preponderance in menopausal women. This study aimed to examine the association between somatosensory dysfunction and BMS in premenopausal, early postmenopausal, and late postmenopausal patients, using a standardized Quantitative Sensory Testing (QST) protocol, and to determine the predictive value of thermal or mechanical perception by QST for detecting BMS. Materials and methodsAn observational case–control study was performed with 36 female participants with BMS (12 premenopausal, 10 early postmenopausal, and 14 late postmenopausal) and 42 age- and sex-matched healthy volunteers (21 premenopausal, 10 early postmenopausal, and 11 late postmenopausal). Neurophysiological tests were used to evaluate somatosensory dysfunction at the tongue. ResultsZ-score in the late postmenopausal BMS group revealed a gain of function for the cold pain threshold and heat pain threshold (Z = 2.08 and 3.38, respectively). In the multiple regression analysis with the Visual Analog Scale as the dependent variable, the vibration detection threshold predicted the severity of burning mouth sensation in the premenopausal group. ConclusionLate postmenopausal patients with BMS showed an increased response of the tongue to noxious thermal stimuli. This supports the theory that changes in sex hormones may affect trigeminal somatosensory function, particularly during the late postmenopausal stage in patients with BMS.

Effects of Novel Vibro-Acupuncture on Healthy Subjects and Those with Experimental and Clinical Pain as Assessed by Quantitative Sensory Testing.

To investigate the analgesic effects of vibro-acupuncture (VA), a novel acuvibrator was developed. Objectives: To compare the analgesic effects of VA with those of manual acupuncture (MA) and placebo acupuncture (PA) on subjects with normal sensory perception (Study I), experimentally induced acute pain (Study II), and clinical chronic pain (Study III). Thirty healthy volunteers (21 males, age: 20-30 years) participated in Study I. Fourteen healthy volunteers (8 males, age: 20-32 years) participated in Study II in which experimental pain was induced by injection of hypertonic saline. Fourteen patients suffering from unilateral epicondylalgia (9 males, age: 30-61 years) participated in Study III. All participants received VA, MA, and PA at LI4 and LI10 points in a randomized, crossover, and double-blinded manner. Quantitative sensory testing (QST) was performed on the ipsilateral forearm before and after each treatment. Data were analyzed using repeated-measures (RM) ANOVA. A significantly higher vibration detection threshold (VDT) was observed after treatment of VA than after MA and PA (p < 0.001). No significant treatment effect on experimental pain intensity was detected (p > 0.086). Significantly lower pain intensity (p = 0.005) and a smaller drawing area (p = 0.011) of unilateral epicondylalgia were found after VA treatment than after PA. A specific effect on the VDT beyond that of MA and PA was evoked by VA. Patients with epicondylitis showed significantly lower pain intensity during VA than during PA. This study indicated that VA may be beneficial in individuals with clinical chronic musculoskeletal pain; however, further studies are needed.

Age Differences in Multimodal Quantitative Sensory Testing and Associations With Brain Volume.

Background and ObjectivesSomatosensory function is critical for successful aging. Prior studies have shown declines in somatosensory function with age; however, this may be affected by testing site, modality, and biobehavioral factors. While somatosensory function declines are associated with peripheral nervous system degradation, little is known regarding correlates with the central nervous system and brain structure in particular. The objectives of this study were to examine age-related declines in somatosensory function using innocuous and noxious stimuli, across 2 anatomical testing sites, with considerations for affect and cognitive function, and associations between somatosensory function and brain structure in older adults.Research Design and MethodsA cross-sectional analysis included 84 “younger” (n = 22, age range: 19–24 years) and “older” (n = 62, age range: 60–94 years) healthy adults who participated in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan study. Participants were assessed on measures of somatosensory function (quantitative sensory testing), at 2 sites (metatarsal and thenar) using standardized procedures, and completed cognitive and psychological function measures and structural magnetic resonance imaging.ResultsSignificant age × test site interaction effects were observed for warmth detection (p = .018, 0.10) and heat pain thresholds (p = .014, 0.12). Main age effects were observed for mechanical, vibratory, cold, and warmth detection thresholds (ps < .05), with older adults displaying a loss of sensory function. Significant associations between somatosensory function and brain gray matter structure emerged in the right occipital region, the right temporal region, and the left pericallosum.Discussion and ImplicationsOur findings indicate healthy older adults display alterations in sensory responses to innocuous and noxious stimuli compared to younger adults and, furthermore, these alterations are uniquely affected by anatomical site. These findings suggest a nonuniform decline in somatosensation in older adults, which may represent peripheral and central nervous system alterations part of aging processes.

Simple Quantitative Sensory Testing Reveals Paradoxical Co-existence of Hypoesthesia and Hyperalgesia in Diabetes.

Background: Diabetic neuropathy is characterized by the paradoxical co-existence of hypo- and hyperalgesia to sensory stimuli. The literature shows consistently sensory differences between healthy and participants with diabetes. We hypothesized that due to differences in pathophysiology, advanced quantitative sensory testing (QST) might reveal sensory discrepancies between type 1 (T1D) and type 2 diabetes (T2D). Furthermore, we investigated whether vibration detection thresholds (VDT) were associated with sensory response.Method: Fifty-six adults with T1D [43 years (28–58)], 99 adults with T2D [65 years (57–71)], and 122 healthy individuals [51 years (34–64)] were included. VDT, pressure pain detection thresholds (pPDT) and tolerance (pPTT), tonic cold pain (hand-immersion in iced water), and central pain mechanisms (temporal summation and conditioned pain modulation) were tested and compared between T1D and T2D. VDT was categorized into normal (< 18 V), intermediary (18–25 V), or high (> 25 V).Results: In comparison to healthy, analysis adjusted for age, BMI, and gender revealed hypoalgesia to tibial (pPDT): p = 0.01, hyperalgesia to tonic cold pain: p < 0.01, and diminished temporal summation (arm: p < 0.01; abdomen: p < 0.01). In comparison to participants with T2D, participants with T1D were hypoalgesic to tibial pPDT: p < 0.01 and pPTT: p < 0.01, and lower VDT: p = 0.02. VDT was not associated with QST responses.Conclusion: Participants with T1D were more hypoalgesic to bone pPDT and pPTT independent of lower VDT, indicating neuronal health toward normalization. Improved understanding of differentiated sensory profiles in T1D and T2D may identify improved clinical endpoints in future trials.

Quantitative sensory testing and norepinephrine levels in REM sleep behaviour disorder – a clue to early peripheral autonomic and sensory dysfunction?

IntroductionStudies have reported autonomic impairment in patients with idiopathic REM sleep behaviour disorder (iRBD), which is considered a prodromal stage of alpha-synucleinopathies. It is still debated whether central or peripheral pathologies are first manifestations of alpha-synucleinopathies. This study aimed to characterize autonomic and somatosensory function in iRBD patients.MethodsThis cross-sectional prospective case–control study included 17 iRBD patients (mean age 66.3 ± 9.2 years) and 16 healthy controls (HCs, 66.6 ± 11.3 years). Quantitative sensory testing, neurological and neuropsychological assessments, norepinephrine blood plasma levels, tilt table examination with orthostatic blood pressure, and heart rate variability were carried out. Longitudinal data of 10 iRBD patients, including neurological, neuropsychological, and tilt table examination, were assessed.ResultsiRBD patients more frequently presented with orthostatic dysfunction than HCs (70.6% vs. 6.3%, p < 0.0001). Supine norepinephrine plasma levels were normal, but lower in iRBD (249.59 ± 99.78 pg/ml iRBD, 354.13 ± 116.38 pg/ml HCs, p < 0.05). Quantitative sensory testing revealed impaired cold (CDT) and vibration detection thresholds (VDT) on the foot in iRBD (CDT foot iRBD − 1.24 ± 0.31, HCs − 9.89E-17 ± 0.25, VDT iRBD − 1.11 ± 0.47, HCs − 1.46E-16 ± 0.25, p < 0.05). Cold detection thresholds differed between the foot and hand among iRBD patients (foot − 1.24 ± 0.31, hand − 0.56 ± 0.25, p < 0.05). Longitudinal data revealed an increase in maximum systolic and diastolic orthostatic blood pressure changes and a decrease in the Valsalva ratio in the follow-up group (p < 0.05).ConclusionThis study revealed autonomic dysfunction with somatosensory impairment, and decreased norepinephrine levels in iRBD, which may serve as a possible prodromal marker for developing alpha-synucleinopathy.

Test-retest and time dependent variation and diagnostic values of vibratory sensation determined by biothesiometer and the Rydel-Seiffer tuning fork.

Background and aimsPolyneuropathy is a common neurological disorder with many potential causes. An essential part in screening, diagnosis, and follow‐up evaluation of polyneuropathy is testing of the sensory function including vibratory sensation. The graduated Rydel‐Seiffer tuning fork and the biothesiometer have been developed to quantify vibratory sensation through detection thresholds. The aim of this study is to compare the vibration detection thresholds determined by the two instruments regarding intraindividual temporal changes, interindividual variation in healthy subjects and comparison of the diagnostic value in patients with a clinical suspicion of polyneuropathy.MethodsNinety‐four healthy subjects, 98 patients with and 97 patients without a diagnosis of polyneuropathy were included. Quantitative sensory testing including biothesiometry, structured clinical examination, and nerve conduction studies were performed three times during 52 weeks in healthy subjects and once in patients.ResultsThere were no significant changes over time for neither the Rydel‐Seiffer tuning fork nor the biothesiometer, and both had larger between‐subject variation than within‐subject variation. Relative intertrial variability was largest for the biothesiometer. Diagnostic value (sensitivity, specificity, positive predictive value, and negative predictive value) was moderate for both methods (Rydel‐Seiffer tuning fork: 58%, 74%, 70%, 64%; biothesiometer: 47%, 77%, 68%, 59%).InterpretationThe Rydel‐Seiffer tuning fork and the biothesiometer have a low test‐retest and time dependent variation. They perform almost equally as diagnostic tools in patients with suspected polyneuropathy with a tendency toward better performance of the tuning fork.

Ala97Ser transthyretin amyloidosis-associated polyneuropathy, clinical and neurophysiological profiles in a Thai cohort

BackgroundAla97Ser transthyretin amyloidosis-associated polyneuropathy (ATTRA97S-PN) is a rare form of inherited polyneuropathy, usually manifesting with late-onset (> 50) progressive polyneuropathy. This mutation is mostly prevalent in Taiwanese and Han-Chinese individuals. The aim of this study was to describe the clinical and comprehensive neurophysiological profiles of ATTRA97S-PN in Thai patients.MethodsThe clinical profiles and serial neurophysiologic studies (nerve conduction study (NCS), quantitative sensory test (QST), and comprehensive autonomic function test (AFT)) of symptomatic ATTRA97S-PN patients who had been followed-up at King Chulalongkorn Memorial Hospital during 2010–2020 were retrospectively reviewed.ResultsNine symptomatic patients (55.6 % were male) from four unrelated families were included. All were Thais of mixed Thai Chinese descent. The mean age of onset was 48.3 (32–60) years. The mean age at diagnosis was 54.8 (33–66) years. Three patients developed early-onset (< 40y) polyneuropathy. The mean Neuropathy Impairment Score was 41.33 (10–92) at diagnosis. Sensory (9/9) and autonomic (9/9) neuropathies were more frequent than motor neuropathy (5/9), which appeared in the late stage of disease. Hypoesthesia in the feet, and gastrointestinal autonomic symptoms were frequently reported as the initial symptoms. The course of neuropathy progressed over years to decades. The worsening of neuropathy tended to progress faster once motor nerves were affected in both clinical and neurophysiological aspects. Concurrent cardiac amyloidosis was found in 6/9 patients. NCS showed length-dependent sensorimotor axonal polyneuropathy in 5/9 patients, and median neuropathy at the wrist (mostly bilateral) in 7/9 patients. QST showed abnormalities in the vibratory detection threshold, the cold detection threshold and the heat pain sensation in 8/9, 8/9 and 7/7 tested patients, respectively. AFT results were abnormal in all. The mean composite autonomic severity score was 5 (3–9).ConclusionsThis clinical study is the first of ATTRA97S-PN in Thai patients. The mixed polyneuropathy-cardiopathy phenotype was the most common manifestation. In this cohort, the age of onset was lower, and the course of neuropathy was relatively longer, than that in previous studies. Some patients may develop early-onset polyneuropathy. This mutation has not yet been documented in any population other than Han Chinese-related populations, probably suggesting a founder effect. Further studies are warranted.

Examining somatosensory function by age, testing site, and modality

The purpose of this study was to systematically examine somatosensory function by age and testing site across a variety of quantitative sensory testing (QST) modalities and determine if age differences were associated with brain gray matter volume and cortical thickness. Healthy younger (n=22; mean (SD) age = 21.31 (1.54) years) and older adults (n=62; mean (SD) age= 72.11 (6.69) years) were recruited as part of the Neuromodulatory Examination of Pain and Mobility Across the Lifespan study. Participants underwent mechanical and thermal detection as well as pain perception applied to two different anatomical sites (metatarsal and thenar). MRI data was collected on a 3-Tesla scanner with a 32-channel radiofrequency coil. A repeated measures ANOVA examined differences in QST by age and test site. Freesurfer examined associations between QST modalities and brain structure in older adults. Significant test site by age interaction effects were observed for warm detection threshold (p=0.018, partial eta2=0.10) and heat pain threshold (p=0.014, partial eta2=0.12). Main effects of age were observed for mechanical detection threshold, vibratory detection threshold, cold detection threshold, warm detection threshold, heat pain threshold, heat pain rating (p's

Oxaliplatin Neuropathy: Predictive Values of Skin Biopsy, QST and Nerve Conduction.

Oxaliplatin-induced peripheral neuropathy negatively affects the quality of life for patients with gastrointestinal cancers and may cause neuropathic pain. Measures of peripheral nerve structure or function, such as intraepidermal nerve fiber density (IENFD) during treatment could reduce neuropathy severity through individualized dose reduction. The aim was to evaluate the predictive values of IENFD, quantitative sensory testing (QST), and nerve conduction studies (NCS) for significant neuropathy and neuropathic pain. Fifty-five patients were examined prospectively before, during, and six months following treatment using skin biopsies, QST and NCS. Clinically significant neuropathy six months after treatment was defined as reduced Total Neuropathy Score of more than five and neuropathic pain was assessed according to International Association for the Study of Pain criteria. Thirty patients had a clinically significant neuropathy, and 14 had neuropathic pain. Vibration detection threshold (VDT) before treatment was correlated with clinically significant neuropathy six months after treatment (OR 0.54, p = 0.01) and reductions in cold detection threshold (CDT) after 25% of treatment (OR 1.38, p = 0.04) and heat pain threshold (HPT) after 50% of treatment (OR 1.91, p = 0.03) with neuropathic pain. Cut off values of 5 for baseline VDT and changes of more than -0.05 °C and -0.85 °C in CDT and HPT were estimated. Sensitivity and specificity was low to moderate. There was no correlation between changes in IENFD or NCS and significant neuropathy or neuropathic pain. Vibration detection thresholds and thermal detection thresholds may be useful for prediction of clinically significant and painful neuropathy, respectively. However, low to moderate sensitivity and specificity may limit the predictive value in clinical practice.

Effect of anodal high-definition transcranial direct current stimulation on the pain sensitivity in a healthy population: a double-blind, sham-controlled study.

High-definition transcranial direct current stimulation (HD-tDCS) of brain areas related to pain processing may provide analgesic effects evident in the sensory detection and pain thresholds. The somatosensory sensitivity was assessed after HD-tDCS targeting the primary motor cortex (M1) and/or the dorsolateral prefrontal cortex (DLPFC). Eighty-one (40 females) subjects were randomly assigned to 1 of 4 anodal HD-tDCS protocols (20 minutes) applied on 3 consecutive days: Sham-tDCS, DLPFC-tDCS, M1-tDCS, and DLPFC&M1-tDCS (simultaneous transcranial direct current stimulation [tDCS] of DLPFC and M1). Subjects and experimenter were blinded to the tDCS protocols. The somatosensory sensitivity were assessed each day, before and after each tDCS by detection and pain thresholds to thermal and mechanical skin stimulation, vibration detection thresholds, and pressure pain thresholds. Subjects were effectively blinded to the protocol, with no significant difference in rates of whether they received real or placebo tDCS between the 4 groups. Compared with the Sham-tDCS, none of the active HD-tDCS protocols caused significant changes in detection or pain thresholds. Independent of tDCS protocols, pain and detection thresholds except vibration detection were increased immediately after the first tDCS protocol compared with baseline (P < 0.05). Overall, the active stimulation protocols were not able to induce significant modulation of the somatosensory thresholds in this healthy population compared with sham-tDCS. Unrelated to the HD-tDCS protocol, a decreased sensitivity was found after the first intervention, indicating a placebo effect or possible habituation to the quantitative sensory testing assessments. These findings add to the increasing literature of null findings in the modulatory effects of HD-tDCS on the healthy somatosensory system.

The relationship between alexithymia, sensory phenotype and neurophysiological parameters in patients with chronic upper limb neuropathy

In this study, we investigated the relationship between sensory abnormalities evaluated by quantitative sensory testing (QST) and alexithymia, depression and anxiety in patients with neuropathic pain involving the upper limbs. We enrolled 62 patients (34 with carpal tunnel syndrome, 7 with brachial plexopathy, 3 with cervical painful radiculopathy, 5 with ulnar entrapment neuropathy at elbow and 13 with post-burn hypertrophic scars) and 48 healthy controls. All underwent nerve conduction studies (NCS), evaluation of cold, heat pain and vibration detection threshold (VDT) by QST and evaluation of alexithymia by Toronto Alexithymia Scale (TAS-20), depression by Beck Depression Inventory II (BDI-II), anxiety by State-Trait Anxiety Inventory (STAI-Y), level of psychological distress by 12-item General Health Questionnaire (GHQ-12) and perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS). The general linear model analysis revealed a significant relationship between TAS-20 overall and TAS-20 sub-score for difficulty identifying feelings and VDT z-scores in the left index with no interaction by year of education and sensory NCS results. Our results demonstrated the association between impairment of vibratory sensation of the left hand, reflecting cutaneous mechanoceptor dysfunction, and alexithymia, particularly the difficulty to identify feelings. The importance of delivering to patients with neuropathic pain personalized care that takes into account not only the neurophysiological aspects but also the aspects of mental functioning is discussed.

Measures of central sensitization and their measurement properties in musculoskeletal trauma: A systematic review.

Chronic pain following musculoskeletal trauma is common, which may partially be attributed to the early presence of central sensitization (CS). Multiple measures are suggested to assess clinical features of CS, yet no systematic review has evaluated the measurement properties of these measures in a musculoskeletal trauma population. This systematic review, which followed a published and PROSPERO registered protocol (CRD42018091531), aimed to establish the scope of CS measures used within a musculoskeletal trauma population and evaluate their measurement properties. Searches were conducted in two stages by two independent reviewers. The Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) checklist was used to evaluate risk of bias and overall quality was assessed using the modified Grading of Recommendations Assessment, Development and Evaluation. From 86 studies, 30 different CS outcome measures were identified. Nine studies evaluated measurement properties of nine outcome measures; eight evaluated reliability and one evaluated construct validity. Measures included seven quantitative sensory testing methods (pressure, cold and electrical pain thresholds; warm, cold and vibration detection thresholds; vibration perception thresholds), pain drawings and a pinwheel. Risk of bias was assessed as doubtful/inadequate for all but one study, overall quality of evidence was low/very low for all measures. Reliability of measures ranged from poor to excellent. Many measures are used to evaluate CS but with limited established measurement properties in musculoskeletal trauma. High quality research to establish measurement properties of CS outcome measures is required.

Metformin may adversely affect orthostatic blood pressure recovery in patients with type 2 diabetes: substudy from the placebo-controlled Copenhagen Insulin and Metformin Therapy (CIMT) trial

BackgroundMetformin has been shown to have both neuroprotective and neurodegenerative effects. The aim of this study was to investigate the effect of metformin in combination with insulin on cardiovascular autonomic neuropathy (CAN) and distal peripheral neuropathy (DPN) in individuals with type 2 diabetes (T2DM).MethodsThe study is a sub-study of the CIMT trial, a randomized placebo-controlled trial with a 2 × 3 factorial design, where 412 patients with T2DM were randomized to 18 months of metformin or placebo in addition to open-labelled insulin. Outcomes were measures of CAN: Changes in heart rate response to deep breathing (beat-to-beat), orthostatic blood pressure (OBP) and heart rate and vibration detection threshold (VDT) as a marker DPN. Serum levels of vitamin B12 and methyl malonic acid (MMA) were analysed.ResultsAfter 18 months early drop in OBP (30 s after standing) was increased in the metformin group compared to placebo: systolic blood pressure drop increased by 3.4 mmHg (95% CI 0.6; 6.2, p = 0.02) and diastolic blood pressure drop increased by 1.3 mmHg (95% CI 0.3; 2.6, p = 0.045) compared to placebo. Beat-to-beat variation decreased in the metformin group by 1.1 beats per minute (95% CI − 2.4; 0.2, p = 0.10). Metformin treatment did not affect VDT group difference − 0.33 V (95% CI − 1.99; 1.33, p = 0.39) or other outcomes. Changes in B12, MMA and HbA1c did not confound the associations.ConclusionsEighteen months of metformin treatment in combination with insulin compared with insulin alone increased early drop in OBP indicating an adverse effect of metformin on CAN independent of vitamin B12, MMA HbA1c.Trial registration The protocol was approved by the Regional Committee on Biomedical Research Ethics (H–D-2007-112), the Danish Medicines Agency and registered with ClinicalTrials.gov (NCT00657943).

Kronik Hemodiyalizli Olguların Ayaklarında Periferik Nöropatinin Araştırılması

Amaç: Çalışmamızda son dönem böbrek hastalığı nedeniyle hemodiyalize giren hastaların ayaklarında nöropatinin araştırılması amaçlandı. Gereç ve Yöntemler: Çalışmaya diabetes mellitus (DM) tanısı olmayan 35 hemodiyaliz hastası (Grup-I), DM tanılı 26 hemodiyaliz hastası (Grup-II), kronik böbrek hastalığı olmayan Tip 2 DM tanılı 50 hastadan (Grup-III) oluşan toplam 111 hasta alındı. Nöropati tespitinde subjektif semptom varlığı, Semmes Weinstein monofilament incelemesi, diyapazon ve biyoteziyometrede vibrasyon algılama eşikleri ile aşil refleksinin varlığı kullanıldı. Gruplarda saptanan veriler analiz edildi. Bulgular: Grup-I’deki hemodiyaliz olguların %17,0’sinde nöropati tespit edilirken, Grup-II’deki DM tanılı hemodiyaliz olguların %69,0’unda, Grup-III’ deki DM tanılı olguların %24,0’ünde nöropati tespit edildi. Grup II’deki nöropati oranı Grup-I ve Grup-III’e göre anlamlı yüksek bulundu (p<0,001). Grup-I ve Grup-III arasında anlamlı fark bulunmadı (p>0,05). Sonuç: Hemodiyaliz hastalarında Diabetes Mellitus olmasa da nöropati sık görülmektedir. Bundan dolayı hemodiyalize giren hastalara düzenli podolojik ayak muayenesinin yapılmasının ve nöropati açısından değerlendirilmesinin uygun olacağını düşünmekteyiz.

Effect of different exercise training intensities on musculoskeletal and neuropathic pain in inactive individuals with type 2 diabetes – Preliminary randomised controlled trial

AimsPeople with type 2 diabetes (T2D) have a greater prevalence of musculoskeletal and neuropathic pain. This exploratory analysis investigated whether exercise of different intensities leads to changes in self-reported musculoskeletal pain or symptoms of diabetic neuropathy in inactive individuals with type 2 diabetes. MethodsThirty-two inactive adults with T2D (59% male, mean age 58.7 ± 9.1yrs, median HbA1c 7.8%) were randomised to usual care (CON), supervised combined aerobic and resistance moderate-intensity continuous training (C-MICT), or supervised combined high-intensity interval training (C-HIIT). At baseline and 8-weeks, musculoskeletal and neuropathic pain were evaluated using a modified Nordic Musculoskeletal Questionnaire and the Neuropathy Total Symptom Score-6 respectively. Quantitative sensory testing was used to determine thermal, mechanical and vibration detection thresholds, as well as pain pressure thresholds. Adverse events were recorded throughout the intervention. ResultsCompared to CON, reduction in musculoskeletal pain intensity was significantly greater for C-HIIT (MD −5.4, 95% CI [−10.6 to −0.2], p = 0.04) and non-significantly greater for C-MICT (MD −5.9 [−12.4 to 0.7], p = 0.08). Changes in neuropathy symptoms were not different between C-HIIT and CON (MD 1.0 [−0.9 to 2.8], p = 0.31), or C-MICT and CON (MD 0.2 [−3.1 to 3.6], p = 0.89). No differences in sensory function were observed between groups. Similar rates of adverse events were seen in both exercise interventions (19 C-HIIT; 17 C-MICT), all but one of which were mild. ConclusionsPreliminary data suggests 8-weeks of high-intensity combined aerobic and resistance exercise may be safely prescribed for inactive individuals with T2D and may reduce musculoskeletal pain but not neuropathic symptoms.Trial Registration:ACTRN12615000475549.

Long-term small-fiber neuropathy and pain sensitization in survivors of pediatric acute lymphoblastic leukemia after stem cell transplantation

PurposeWe aimed at describing for the first time peripheral small-fiber neurotoxicity and pain sensitization in survivors of pediatric acute lymphoblastic leukemia after stem cell transplantation (SCT).MethodsIn a cross-sectional, retrospective, single-center study, we assessed 25 relapse-free long-term survivors (median age at SCT: 11 ± 4.9 years; median time between SCT and testing: 8.25 years, 19 males) using a reduced version of the pediatric-modified total neuropathy score for clinical assessment and Quantitative Sensory Testing (QST). Inclusion criteria: ge 6 years old at testing, le 18 years old at time of SCT, ge 1 year between SCT and testing.ResultsNine patients (36%) had peripheral neuropathy as defined by the clinical red-pmTNS (≥ 4). The QST parameters mechanical pain sensitivity, mechanical detection threshold, thermal sensory limen, vibration detection threshold and pressure pain threshold were significantly abnormal in the survivor cohort (p < 0.0038). Except for one, all survivors showed at least one abnormal QST parameter. When using QST, signs of small and large fiber dysfunction were present in 22 (88%) and 17 (68%) survivors, respectively. More than half of all survivors were found to experience pathologic sensitization to pain.Conclusions and implications for cancer survivorsSurvivors of pediatric acute lymphoblastic leukemia after SCT are at high risk for long-term peripheral neuropathy with a dominating small-fiber and pain sensitization pattern.

Swallowing impairment in older adults: association with sensorimotor peripheral nerve function from the Health, Aging and Body Composition study.

The purpose of this study was to examine whether impairments in sensorimotor peripheral nerve function are associated with a higher likelihood of swallowing impairment in older adults. Health, Aging and Body Composition participants (n = 607, age = 75.8 ± 2.7years, 55.8% women, 32.3% black) underwent peripheral nerve testing at Year 4 and 11 with swallowing difficulty assessed at Year 4 and 15. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with the vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower extremity peripheral neuropathy and difficulty swallowing were collected by self-report. Data analysis was performed using a hierarchical approach. Odds ratios (ORs) were estimated using non-conditional logistic regression. At Year 15 108 (17.8%) participants had swallowing impairments. In fully adjusted models, the peripheral nerve impairments associated with swallowing impairment were numbness (OR 4.67; 95%CI 2.24-9.75) and poor motor nerve conduction velocity (OR 2.26; 95%CI 1.08-4.70). Other peripheral nerve impairments were not related to swallowing. The association between slow motor nerve conduction velocity and numbness and a higher likelihood of swallowing difficulties a decade later in our prospective study identifies an important area for further investigation in older adults.

Quantitative Sensory Changes Following Gasserian Ganglion Radiofrequency Thermocoagulation in Patients with Medical Refractory Trigeminal Neuralgia: A Prospective Consecutive Case Series.

Microsurgical vascular nerve decompression and percutaneous ablative interventions aiming at the Gasserian ganglion are promising treatment modalities for patients with medical refractory trigeminal neuralgia (TN). Apart from clinical reports on a variable manifestation of facial hypoesthesia, the long-term impact of trigeminal ganglion radiofrequency thermocoagulation (RFT) on sensory characteristics has not yet been determined using quantitative methods. We performed standardized quantitative sensory testing according to the established protocol of the German Research Network on Neuropathic Pain in a cohort of patients with classical (n = 5) and secondary (n = 11) TN before and after percutaneous Gasserian ganglion RFT (mean follow-up: 6 months). The test battery included thermal detection and thermal pain thresholds as well as mechanical detection and mechanical pain sensitivity measures. Clinical improvement was also assessed by means of renowned pain intensity and impairment questionnaires (Short-Form McGill Pain Questionnaire, Pain Disability Index, and Pain Catastrophizing Scale), pain numeric rating scale, and anti-neuropathic medication reduction at follow-up. All clinical parameters developed favorably following percutaneous thermocoagulation. Only mechanical and vibration detection thresholds of the affected side of the face were located below the reference frame of the norm population before and after the procedure. Statistically significant persistent changes in quantitative sensory variables caused by the intervention could not be detected in our patient sample. Our data suggest that TN patients improving considerably after RFT do not undergo substantial long-term alterations regarding quantitative sensory perception.

Erratum to: Quantitative Sensory Testing in Patients with Multisomatoform Disorder with Chronic Pain as the Leading Bodily Symptom-a Matched Case-Control Study.

OBJECTIVE Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8-20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients. DESIGN We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls. RESULTS There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results. CONCLUSIONS The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.