1
|
Cosentino G, Antoniazzi E, Bonomi L, Cavigioli C, D'Agostino M, Todisco M, Tassorelli C. Age-, gender- and body site-specific reference values of thermal Quantitative Sensory Testing in the Italian population using the Q-sense device. Neurol Sci 2023; 44:4481-4489. [PMID: 37450073 PMCID: PMC10641050 DOI: 10.1007/s10072-023-06929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Age-, gender- and body site-specific values of thermal Quantitative Sensory Testing (QST) measures have not yet been reported using the novel and cheap device 'Q-sense'. Here, we aimed to assess normative values of Q-sense-derived parameters in a representative Italian population. METHODS QST parameters were measured in 84 healthy participants (42 males; aged 20-76 years) equally distributed into three age groups (18-39, 40-59 and 60-80 years). We explored the Warm and the Cold Detection Thresholds (WDT and CDT, respectively) with the method of limits (MLI) and the method of levels (MLE), and the Heat Pain Threshold (HPT) with the MLI. We tested the trigeminal supraorbital region, the hand thenar, and the foot dorsum on the right body side. RESULTS We calculated non-parametric reference limits (2.5-97.5th) according to age, gender and tested site. All QST measures were affected by age, gender and tested site. In the extra-trigeminal body sites, females showed lower WDT and higher CDT, while males had higher HPT. Worse sensory discriminative abilities and increased HPT values were found in people aged over 40 on the foot. Age-related differences were more evident with the reaction time-dependent MLI vs. MLE paradigm. CONCLUSIONS Demographic characteristics must be considered when QST is used in the clinical setting. The definition of reference limits for sensory testing with the Q-sense herein provided can pave the way towards a more widespread use of thermal QST for diagnosing small fiber neuropathy and for identifying patients' profiles in different chronic pain syndromes.
Collapse
Affiliation(s)
- Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Elisa Antoniazzi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Laura Bonomi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Camilla Cavigioli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | | | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
2
|
Kwon J, Cho K, Jung D, Lee JY. Cutaneous warmth and hotness thresholds to radiation heat exposure at a distance of 10 cm from 17 body regions. J Therm Biol 2023; 115:103611. [PMID: 37354636 DOI: 10.1016/j.jtherbio.2023.103611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/04/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
The purpose of the present study was to evaluate body regional differences in cutaneous warmth and hotness thresholds in relation to radiant heat exposure. Fourteen male subjects participated in this study (age: 25 ± 5 y, height: 176.6 ± 5.5 cm, body weight: 70 ± 5.8 kg). Cutaneous warmth and hotness thresholds were measured on the forehead, neck, chest, abdomen, upper back, lower back, upper arm, forearm, palm, back of hand, front thigh, shin, top of foot, buttock, back thigh, calf, and sole. The forehead (34.8 ± 0.2 °C), lower back (34.1 ± 1.2 °C) and palm (34.3 ± 0.7 °C) had the highest warmth thresholds, whereas the foot (29.8 ± 1.9 °C) and sole (28.0 ± 2.1 °C) had the lowest values among the 17 regions (P<0.001). Higher warmth thresholds were related to higher initial skin temperatures (Tsk) (r=0.972, P<0.001). Increases in Tsk for detecting warmth sensation were smaller for the lower back with a rise of 0.2 ± 0.4 °C and the abdomen (0.3 ± 0.3 °C) than for the buttock (0.9 ± 0.8 °C) and sole (0.8 ± 0.6 °C) (P<0.05). Increases in Tsk for detecting hotness sensation ranged from 0.5 to 1.5 °C. Warmth and hotness thresholds on the abdomen or sole had significant relationships with body mass index, indicating that the overweight are less sensitive to detecting radiant heat on the abdomen or sole. Thermal thresholds from radiant heat exposure of 100 cm2 were lower than the values from conductive heat exposure of 6.25 cm2, which might be explained by the effect of spatial summation.
Collapse
Affiliation(s)
- JuYoun Kwon
- Research Institute of Human Ecology, Seoul National University, South Korea
| | - Kayoung Cho
- Department of Textiles, Merchandising and Fashion Design, Seoul National University, South Korea
| | - Dahee Jung
- Department of Textiles, Merchandising and Fashion Design, Seoul National University, South Korea
| | - Joo-Young Lee
- Research Institute of Human Ecology, Seoul National University, South Korea; Department of Textiles, Merchandising and Fashion Design, Seoul National University, South Korea; Graphene-Interdisciplinary Research Center, Advanced Institute of Convergence Technology, South Korea.
| |
Collapse
|
3
|
Dunker Ø, Lie MU, Nilsen KB. Can within-subject comparisons of thermal thresholds be used for diagnostic purposes? Clin Neurophysiol Pract 2021; 6:63-71. [PMID: 33665518 PMCID: PMC7905396 DOI: 10.1016/j.cnp.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/23/2020] [Accepted: 01/04/2021] [Indexed: 11/05/2022] Open
Abstract
Normal limits for within-subject comparisons of thermal thresholds are wide. Our findings advocate for site-specific normal values of adequate resolution. The difference between distal and proximal thresholds increase drastically with age.
Objective Quantitative thermal testing (QTT) is a psychophysical assessment method of small nerve fibers that relies on reference material to assess function. Normal limits for within-subject comparisons of thermal thresholds are scarce, and their association with age, height and sex is not fully elucidated. The aim of this study was to investigate the normal limits for distal-proximal– and contralateral homologous comparisons of thermal thresholds with QTT, and their association with age, sex or height. Methods Fifty healthy volunteers ages 20–79 participated in the experiment. Cold detection thresholds (CDT), warm detection thresholds (WDT), heat pain thresholds (HPT), and cold pain thresholds (CPT) were measured bilaterally at the thenar eminence, anterior thigh, distal medial leg and foot dorsum. Sample normal limits were calculated as (mean) ± 2 SD. Results Forty-eight subjects were included in the analysis. CPT was excluded from all analyses due to a large floor-effect. Sample normal limits for side-differences ranged from 1.8 to 7.2 °C for CDT, 2.4–6.8 °C for WDT and 3.2–4.0 °C for HPT, depending on anatomical site. For distal-proximal comparisons, sample normal limits ranged from 4.0 to 8.7 °C for CDT, 6.0–14.0 °C for WDT and 4.2–9.0 °C for HPT, depending on the pairs compared. Age was associated with side-differences for CDT in the thenar eminences (p < 0.001) and distal medial legs (p < 0.002), and with 11 of 18 distal-proximal comparisons (p < 0.01). Conclusions The normal limits for distal-proximal- and contralateral homologous thermal thresholds were wide, and thus of limited use in a clinical setting, although the reported values may be somewhat inflated by low sample-size and consequent age-pooling. Age, but not sex or height, was associated with contralateral differences in CDT in the thenar eminences and distal medial legs, and with most distal-proximal differences. Significance Due to wide normal limits, we advise caution when utilizing relative comparisons of thermal thresholds for diagnostic purposes.
Collapse
Affiliation(s)
- Ø Dunker
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
| | - M U Lie
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - K B Nilsen
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
4
|
Jin HY, Moon SS, Calcutt NA. Lost in Translation? Measuring Diabetic Neuropathy in Humans and Animals. Diabetes Metab J 2021; 45:27-42. [PMID: 33307618 PMCID: PMC7850880 DOI: 10.4093/dmj.2020.0216] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
The worldwide diabetes epidemic is estimated to currently afflict almost 500 million persons. Long-term diabetes damages multiple organ systems with the blood vessels, eyes, kidneys and nervous systems being particularly vulnerable. These complications of diabetes reduce lifespan, impede quality of life and impose a huge social and economic burden on both the individual and society. Peripheral neuropathy is a debilitating complication that will impact over half of all persons with diabetes. There is no treatment for diabetic neuropathy and a disturbingly long history of therapeutic approaches showing promise in preclinical studies but failing to translate to the clinic. These failures have prompted re-examination of both the animal models and clinical trial design. This review focuses on the functional and structural parameters used as indices of peripheral neuropathy in preclinical and clinical studies and the extent to which they share a common pathogenesis and presentation. Nerve conduction studies in large myelinated fibers have long been the mainstay of preclinical efficacy screening programs and clinical trials, supplemented by quantitative sensory tests. However, a more refined approach is emerging that incorporates measures of small fiber density in the skin and cornea alongside these traditional assays at both preclinical and clinical phases.
Collapse
Affiliation(s)
- Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
USA
| | - Seong-Su Moon
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju,
USA
- Division of Endocrinology, Department of Internal Medicine, Nazareth General Hospital, Daegu,
Korea,
USA
| | - Nigel A. Calcutt
- Department of Pathology, University of California San Diego, La Jolla, CA,
USA
| |
Collapse
|
5
|
Thermal sensitivity mapping - warmth and cold detection thresholds of the human torso. J Therm Biol 2020; 93:102718. [PMID: 33077130 DOI: 10.1016/j.jtherbio.2020.102718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Skin as the largest organ of the human body accomplishes many important functions, including thermoregulation. In this context, investigating cold (CDT) and warmth detection thresholds (WDT) constitutes an important research branch, and investigating thermal thresholds has a significant impact on the clothing and fabric textile industry. In this regard, not only the extremities, but also torso regions are of high relevance. However, only few examinations have conducted detailed mapping studies of the human torso. Additionally, some of these studies show certain methodological limitations. Furthermore, the issue of whether cutaneous thermal sensitivity is gender-dependent is still controversial. Therefore, the present study investigated the cutaneous thermal sensitivity (CDT, WDT) of 42 male and female young and healthy subjects. Measurements were taken at 11 anatomical regions. We found that gender plays an important role when investigating thermal thresholds: Females tended to be more sensitive than males. We also found considerable differences between the tested regions, even within the anterior torso, for example. We identified locations which were constantly sensitive (lower back), while others were consistently insensitive (e.g. scapula). We also detected greater data variability for males compared to females, and for WDT compared to CDT. Furthermore, mainly for WDT, we found a proximal-to-distal increase of thermal torso and upper arm sensitivity. In line with previous investigations, our subjects were more sensitive to cold than to warmth. The findings of this study have important implications. First, our data may complement basic research, e.g. in terms of reference data of body regional maps. Second, our data provides important insights that could be leveraged in the textile industry, and also used to optimize current broadly applicable test methods and tools, like thermal manikins and thermophysiological models.
Collapse
|
6
|
CRPS Is Not Associated with Altered Sensorimotor Cortex GABA or Glutamate. eNeuro 2020; 7:ENEURO.0389-19.2020. [PMID: 31980452 PMCID: PMC7029188 DOI: 10.1523/eneuro.0389-19.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/18/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a debilitating chronic pain disorder typically in the upper or lower limbs. While CRPS usually develops from a peripheral event, it is likely maintained by CNS changes. Indeed, CRPS is reported to be associated with sensorimotor cortex changes, or functional “reorganization,” as well as deficits such as poor tactile acuity. While the mechanisms underpinning cortical reorganization in CRPS are unknown, some have hypothesized that it involves disinhibition (i.e., a reduction in GABA activity). In this study, we addressed this hypothesis by using edited magnetic resonance spectroscopy to determine sensorimotor GABA and glutamate concentrations in 16 humans with CRPS and 30 matched control subjects and the relationship of these concentrations with tactile acuity. We found that individuals with upper limb CRPS displayed reduced tactile acuity in the painful hand, compared with the nonpainful hand and pain-free control subjects. Despite this acuity deficit, CRPS was not associated with altered GABA or glutamate concentrations within the sensorimotor cortex on either the side that represents the affected or unaffected hand. Furthermore, there was no significant relationship between sensorimotor GABA or glutamate concentrations and tactile acuity in CRPS subjects or control subjects. Although our sample was small, these data suggest that CRPS is not associated with altered total sensorimotor GABA or glutamate concentrations. While these results are at odds with the sensorimotor cortex disinhibition hypothesis, it is possible that GABAergic mechanisms other than total GABA concentration may contribute to such disinhibition.
Collapse
|
7
|
Ekman L, Persson Löfgren J, Dahlin LB. Examining practice effects in repeated measurements of vibration perception thresholds on finger pulps of healthy individuals - Is it possible to improve your results over a clinically relevant test interval? PLoS One 2019; 14:e0226371. [PMID: 31846492 PMCID: PMC6917284 DOI: 10.1371/journal.pone.0226371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 11/25/2019] [Indexed: 11/20/2022] Open
Abstract
Aims To investigate practice effects in a test-retest situation, where vibration perception thresholds (VPT) were measured in healthy subjects using a multi-frequency test method. Methods In eight consecutive tests, VPTs were tested in the pulps of the index and little fingers at seven frequencies (8, 16, 32, 64, 125, 250 and 500 Hz). Subjects were twenty healthy adults aged 26 to 65 years (mean 46.0 ± 11.1 years; 10 male and 10 female). The subjects were examined at six tests with intervals of one month (mean 33 ± 6; time 0 to month 5) and at two additional tests with prolonged intervals (month 12 and 18). Linear mixed model analysis was performed to investigate differences over the subsequent test occasions. To examine where potential practice effects occurred, a pairwise comparison with Bonferroni correction was made. Results Small decreases in VPTs were found in 8 out of the 14 frequencies (index finger: 8, 16, 32, 250 and 500 Hz; little finger: 16, 250 and 500 Hz) within the test period from time 0 to month 5. In tests at 12 and 18 months, VPTs were increased compared to month 5, but lowered in comparison with time 0. Hence, minor significant decreases were found in three frequencies for the index finger (125, 250 and 500 Hz) and one frequency for the little finger (250 Hz) when examining VPTs with prolonged time intervals. Conclusions When evaluating vibration perception thresholds in a clinically relevant time period of once or twice a year, no consideration of practice effects is necessary when interpreting the results.
Collapse
Affiliation(s)
- Linnéa Ekman
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Jin Persson Löfgren
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
8
|
Siebenga PS, van Amerongen G, Okkerse P, Denney WS, Dua P, Butt RP, Hay JL, Groeneveld GJ. Reproducibility of a battery of human evoked pain models to detect pharmacological effects of analgesic drugs. Eur J Pain 2019; 23:1129-1140. [PMID: 30793411 PMCID: PMC6618124 DOI: 10.1002/ejp.1379] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/01/2019] [Accepted: 02/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although reproducibility is considered essential for any method used in scientific research, it is investigated only rarely; thus, strikingly little has been published regarding the reproducibility of evoked pain models involving human subjects. Here, we studied the reproducibility of a battery of evoked pain models for demonstrating the analgesic effects of two analgesic compounds. METHODS A total of 81 healthy subjects participated in four studies involving a battery of evoked pain tests in which mechanical, thermal and electrical stimuli were used to measure pain detection and tolerance thresholds. Pharmacodynamic outcome variables were analysed using a mixed model analysis of variance, and a coefficient of variation was calculated by dividing the standard deviation by the least squares means. RESULTS A total of 76 subjects completed the studies. After being administered pregabalin, the subjects' pain tolerance thresholds in the cold pressor and pressure stimulation tests were significantly increased compared to the placebo group. Moreover, the heat pain detection threshold in UVB-irradiated skin was significantly increased in subjects who were administered ibuprofen compared to the placebo group. Variation among all evoked pain tests ranged from 2.2% to 30.6%. CONCLUSIONS Four studies using a similar design showed reproducibility with respect to the included evoked pain models. The relatively high consistency and reproducibility of two analgesics at doses known to be effective in treating clinically relevant pain supports the validity of using this pain test battery to investigate the analgesic activity and determine the active dosage of putative analgesic compounds in early clinical development. SIGNIFICANCE The consistency and reproducibility of measuring the profile of an analgesic at clinically relevant doses illustrates that this pain test battery is a valid tool for demonstrating the analgesic activity of a test compound and for determining the optimal active dose in early clinical drug development.
Collapse
Affiliation(s)
| | | | | | - William S. Denney
- Pfizer Inc.CambridgeMassachusetts
- Present address:
Human Predictions LLCCambridgeMassachusetts
| | | | | | | | - Geert J. Groeneveld
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden University Medical CenterLeidenThe Netherlands
| |
Collapse
|
9
|
Ferland CE, Villemure C, Michon PE, Gandhi W, Ma ML, Chouchou F, Parent AJ, Bushnell MC, Lavigne G, Rainville P, Ware MA, Jackson PL, Schweinhardt P, Marchand S. Multicenter assessment of quantitative sensory testing (QST) for the detection of neuropathic-like pain responses using the topical capsaicin model. Can J Pain 2018; 2:266-279. [PMID: 35005384 PMCID: PMC8730652 DOI: 10.1080/24740527.2018.1525682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background The use of quantitative sensory testing (QST) in multicenter studies has been quite limited, due in part to lack of standardized procedures among centers. Aim The aim of this study was to assess the application of the capsaicin pain model as a surrogate experimental human model of neuropathic pain in different centers and verify the variation in reports of QST measures across centers. Methods A multicenter study conducted by the Quebec Pain Research Network in six laboratories allowed the evaluation of nine QST parameters in 60 healthy subjects treated with topical capsaicin to model unilateral pain and allodynia. The same measurements (without capsaicin) were taken in 20 patients with chronic neuropathic pain recruited from an independent pain clinic. Results Results revealed that six parameters detected a significant difference between the capsaicin-treated and the control skin areas: (1) cold detection threshold (CDT) and (2) cold pain threshold (CPT) are lower on the capsaicin-treated side, indicating a decreased in cold sensitivity; (3) heat pain threshold (HPT) was lower on the capsaicin-treated side in healthy subjects, suggesting an increased heat pain sensitivity; (4) dynamic mechanical allodynia (DMA); (5) mechanical pain after two stimulations (MPS2); and (6) mechanical pain summation after ten stimulations (MPS10), are increased on the capsaicin-treated side, suggesting an increased in mechanical pain (P < 0.002). CDT, CPT and HPT showed comparable effects across all six centers, with CPT and HPT demonstrating the best sensitivity. Data from the patients showed significant difference between affected and unaffected body side but only with CDT. Conclusion These results provide further support for the application of QST in multicenter studies examining normal and pathological pain responses.
Collapse
Affiliation(s)
- Catherine E Ferland
- Quebec Pain Research Network, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre, Shriners Hospitals for Children-Canada, Montreal, QC, Canada.,Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Chantal Villemure
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Pierre-Emmanuel Michon
- Division des Neurosciences cliniques et cognitives, centre de recherche CERVO, Université Laval, Quebec, QC, Canada
| | - Wiebke Gandhi
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - My-Linh Ma
- Research Centre, Shriners Hospitals for Children-Canada, Montreal, QC, Canada
| | - Florian Chouchou
- Département santé buccale, Faculté de médecine dentaire, Université de Montréal, Montreal, QC, Canada
| | - Alexandre J Parent
- Quebec Pain Research Network, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - M Catherine Bushnell
- National Centre for Complementary and Integrative Health, NIH, Bethesda, MD, USA
| | - Gilles Lavigne
- Quebec Pain Research Network, Université de Sherbrooke, Sherbrooke, QC, Canada.,Département santé buccale, Faculté de médecine dentaire, Université de Montréal, Montreal, QC, Canada
| | - Pierre Rainville
- Quebec Pain Research Network, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada.,Département de stomatologie, Faculté de médecine dentaire, Université de Montréal, Montreal, QC, Canada
| | - Mark A Ware
- Quebec Pain Research Network, Université de Sherbrooke, Sherbrooke, QC, Canada.,Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Philip L Jackson
- Quebec Pain Research Network, Université de Sherbrooke, Sherbrooke, QC, Canada.,Division des Neurosciences cliniques et cognitives, centre de recherche CERVO, Université Laval, Quebec, QC, Canada.,School of Psychology, Université Laval, Quebec, QC, Canada
| | - Petra Schweinhardt
- Quebec Pain Research Network, Université de Sherbrooke, Sherbrooke, QC, Canada.,Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Serge Marchand
- Quebec Pain Research Network, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche du CHUS, Sherbrooke, QC, Canada.,Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Québec, Canada
| |
Collapse
|
10
|
Tang KPM, Chau KH, Kan CW, Fan JT. Assessing the accumulated stickiness magnitude from fabric-skin friction: effect of wetness level of various fabrics. ROYAL SOCIETY OPEN SCIENCE 2018; 5:180860. [PMID: 30225075 PMCID: PMC6124082 DOI: 10.1098/rsos.180860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/24/2018] [Indexed: 06/08/2023]
Abstract
Increasing skin wetness tends to increase fabric-skin adhesion and friction, resulting in wear discomfort or skin injuries. Here, the magnitude estimation approach was used to assess the stickiness sensation perceived in fabrics. Seven fabric types were wetted by putting onto wet 'skin' surface and dried for different durations to achieve different wetness levels, simulating wearing conditions during the recovery period after sweating. Results showed that the relationship between magnitude estimates of stickiness and amount of water present in fabric demonstrated a power function. The exponents and constant from power regression show the growth rate of stickiness sensation with moisture intensity and the perceived stickiness under fixed stimulus intensity, respectively. A novel parameter, accumulated stickiness magnitude (ASM), describing how much discomfort a wetted fabric offered throughout the drying period, was developed. Thin cotton fabrics (fabric W01 and W03), having higher saturation level after contacting with wetted skin surface, arouse stronger stickiness feeling and their ASM is remarkably higher. The difference in stickiness estimates is due to the difference in chemical composition and surface geometry. This study suggests us the way to predict perceived stickiness in fabrics with different wetness levels which is useful for applications like sportswear, intimate apparel or healthcare products.
Collapse
Affiliation(s)
- Ka-Po Maggie Tang
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Kam-Hong Chau
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chi-Wai Kan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jin-tu Fan
- College of Human Ecology, Cornell University, Ithaca, NY 14853, USA
| |
Collapse
|
11
|
Takeda R, Imai D, Suzuki A, Ota A, Naghavi N, Yamashina Y, Hirasawa Y, Yokoyama H, Miyagawa T, Okazaki K. Thermal sensation during mild hyperthermia is modulated by acute postural change in humans. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2016; 60:1925-1932. [PMID: 27146287 DOI: 10.1007/s00484-016-1179-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 04/21/2016] [Accepted: 04/23/2016] [Indexed: 06/05/2023]
Abstract
Thermal sensation represents the primary stimulus for behavioral and autonomic thermoregulation. We assessed whether the sensation of skin and core temperatures for the driving force of behavioral thermoregulation was modified by postural change from the supine (Sup) to sitting (Sit) during mild hyperthermia. Seventeen healthy young men underwent measurements of noticeable increase and decrease (±0.1 °C/s) of skin temperature (thresholds of warm and cold sensation on the skin, 6.25 cm2 of area) at the forearm and chest and of the whole-body warm sensation in the Sup and Sit during normothermia (NT; esophageal temperature (Tes), ∼36.6 °C) and mild hyperthermia (HT; Tes, ∼37.2 °C; lower legs immersion in 42 °C of water). The threshold for cold sensation on the skin at chest was lower during HT than NT in the Sit (P < 0.05) but not in Sup, and at the forearm was lower during HT than NT in the Sup and further in Sit (both, P < 0.05), with interactive effects of temperature (NT vs. HT) × posture (Sup vs. Sit) (chest, P = 0.08; forearm, P < 0.05). The threshold for warm sensation on the skin at both sites remained unchanged with changes in body posture or temperature. The whole-body warm sensation was higher during HT than NT in both postures and higher in the Sit than Sup during both NT and HT (all, P < 0.05). Thus, thermal sensation during mild hyperthermia is modulated by postural change from supine to sitting to sense lesser cold on the skin and more whole-body warmth.
Collapse
Affiliation(s)
- Ryosuke Takeda
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Daiki Imai
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
- Research Center for Urban Health and Sports, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Akina Suzuki
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Akemi Ota
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Nooshin Naghavi
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Yoshihiro Yamashina
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Yoshikazu Hirasawa
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Hisayo Yokoyama
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
- Research Center for Urban Health and Sports, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Toshiaki Miyagawa
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
- Research Center for Urban Health and Sports, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan
| | - Kazunobu Okazaki
- Department of Environmental Physiology for Exercise, Osaka City University Graduate School of Medicine, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan.
- Research Center for Urban Health and Sports, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi, Osaka, 558-8585, Japan.
| |
Collapse
|
12
|
Ceynowa M, Mazurek T, Pankowski R, Rocławski M, Treder M. The Thermal Sensitivity Test in Evaluating Outcome after Peripheral Nerve Injury. BIOMED RESEARCH INTERNATIONAL 2015; 2015:528356. [PMID: 26199942 PMCID: PMC4493271 DOI: 10.1155/2015/528356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the ability to discriminate temperatures in patients following peripheral nerve injury. Knowing that temperature sensibility is mediated by different receptors, the scores were compared to other functional hand scores in order to determine whether the ability to discriminate temperatures is restored to a different extent compared with other commonly evaluated hand function modalities. The test was performed using the NTE-2 device (Physitemp Instruments Inc., 154 Huron Avenue, Clifton, New Jersey, USA). Out of 57 patients, 27 had normal thermal discrimination scores, and 9 could not tell the temperatures apart in the differences set on the measuring device. Overall, patients with better thermal discrimination had also better hand function as evaluated with different methods. However, some patients who did regain the ability to differentiate temperatures correctly did not have any measurable return of hand function in other tests. Thermal discrimination scores correlated similarly with different functional scores, except for vibration sensibility, which did not show any significant correlation. The development and severity of cold intolerance seem to be unrelated to temperature sense.
Collapse
Affiliation(s)
- Marcin Ceynowa
- Department of Orthopedic Surgery, Medical University of Gdańsk, Ulica Nowe Ogrody 1-6, 80-803 Gdańsk, Poland
| | - Tomasz Mazurek
- Department of Orthopedic Surgery, Medical University of Gdańsk, Ulica Nowe Ogrody 1-6, 80-803 Gdańsk, Poland
| | - Rafał Pankowski
- Department of Orthopedic Surgery, Medical University of Gdańsk, Ulica Nowe Ogrody 1-6, 80-803 Gdańsk, Poland
| | - Marek Rocławski
- Department of Orthopedic Surgery, Medical University of Gdańsk, Ulica Nowe Ogrody 1-6, 80-803 Gdańsk, Poland
| | - Mariusz Treder
- Department of Orthopedic Surgery, Medical University of Gdańsk, Ulica Nowe Ogrody 1-6, 80-803 Gdańsk, Poland
| |
Collapse
|
13
|
Szczyrba S, Kozera GM, Neubauer-Geryk J, Wolnik B, Nyka WM, Bieniaszewski L. Diabetic symmetric polyneuropathy is associated with increased aortal stiffening but not cerebral angiopathy in type 1 diabetes. J Diabetes Complications 2015; 29:73-6. [PMID: 25456818 DOI: 10.1016/j.jdiacomp.2014.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/22/2014] [Accepted: 10/02/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Diabetic symmetric polyneuropathy (DSP) and cerebral microangiopathy are common complications of type 1 diabetes (T1DM). However, little is known about associations between DSP, cerebral microcirculation and macrovascular injury in T1DM. We aimed to assess relationships between those complications. MATERIAL AND METHODS We examined 42 patients (25 females; mean age 37.1±5.6years) with T1DM (mean disease duration 20.6±6.1years). DSP was diagnosed with the use of quantitative vibration sensory testing (QVST) and Michigan Neuropathy Screening Instrument (MNSI). Cerebral microvasculature was evaluated with measurements of vasomotor reactivity reserve (VMR) and pulsatility index (PI) of middle cerebral artery, macroangiopathic injury by measuring intima-media complex thickness (IMT) in the common carotid artery and carotid-femoral pulse-wave velocity (PWV). RESULTS Patients with DSP (33.3%) showed higher PWV than those without DPS (10.5 vs 9.1m/s; P=0.03); no differences concerning VMR, PI or IMT existed. There were correlations between PWV and vibration perception thresholds (VPT) (r=0.44; P=0.004) and MNSI score (r=0.43; P=0.003); VPT showed impact on PWV (beta 0.34; P<0.03). CONCLUSIONS DSP is associated with systemic macroangiopathy, reflected by increased carotid-femoral PWV, but not with the cerebral macro- and microangiopathy.
Collapse
Affiliation(s)
| | - Grzegorz M Kozera
- Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Bogumił Wolnik
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Walenty M Nyka
- Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | | |
Collapse
|
14
|
Wakolbinger R, Roche AD, Stockinger T, Gustorff B, Aszmann OC. Multiregion thermal sensitivity mapping of the hand. J Plast Reconstr Aesthet Surg 2014; 67:1541-7. [DOI: 10.1016/j.bjps.2014.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/20/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
|
15
|
Maffei L, Premrou V, Roldan P, Copetti M, Pellegrini F, Rossi MC, Vespasiani G. Vibration perception threshold in the screening of sensorimotor distal symmetric polyneuropathy: the need of more accurate age-specific reference values. J Diabetes Sci Technol 2014; 8:621-2. [PMID: 24876629 PMCID: PMC4455454 DOI: 10.1177/1932296814527818] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Laura Maffei
- Consultorios Asociados de Endocrinología, Buenos Aires, Argentina
| | - Valeria Premrou
- Consultorios Asociados de Endocrinología, Buenos Aires, Argentina
| | - Patricia Roldan
- Consultorios Asociados de Endocrinología, Buenos Aires, Argentina
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
| | - Fabio Pellegrini
- Unit of Biostatistics, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - Maria Chiara Rossi
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - Giacomo Vespasiani
- Diabetes Unit, "Madonna del Soccorso" Hospital, San Benedetto del Tronto, Italy
| |
Collapse
|
16
|
Kemp J, Després O, Pebayle T, Dufour A. Age-related decline in thermal adaptation capacities: an evoked potentials study. Psychophysiology 2014; 51:539-45. [PMID: 24611695 DOI: 10.1111/psyp.12202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 01/17/2014] [Indexed: 11/26/2022]
Abstract
Aging is associated with changes in thermosensitivity and decreases in the functionality of the autonomic thermoregulation. The underlying mechanisms are, however, not fully understood. Elderly subjects may undergo functional changes in the integration process of the thermal sensory system, especially in their thermal adaptation capacities. To verify this hypothesis, we compared thermal evoked responses in younger and older subjects exposed to thermoneutral (27 °C) and warm (30 °C) environments. In the warm environment, the amplitudes of thermal evoked potentials (EPs) were significantly lower in older than in younger subjects, whereas in the thermoneutral environment, the EP amplitudes were similar in both groups. These findings suggest that thermal adaptation capacities are reduced in elderly individuals, due to a dysfunction of C-fibers with aging, particularly expressed by lowered adaptation capacities to temperature variations.
Collapse
Affiliation(s)
- Jennifer Kemp
- Laboratoire de Neurosciences Cognitives et Adaptatives, UMR 7364, Université de Strasbourg, CNRS, Strasbourg, France
| | | | | | | |
Collapse
|
17
|
Dyck PJ, Argyros B, Russell JW, Gahnstrom LE, Nalepa S, Albers JW, Lodermeier KA, Zafft AJ, Dyck PJB, Klein CJ, Litchy WJ, Davies JL, Carter RE, Melton LJ. Multicenter trial of the proficiency of smart quantitative sensation tests. Muscle Nerve 2014; 49:645-53. [PMID: 23929701 DOI: 10.1002/mus.23982] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 11/07/2022]
Abstract
INTRODUCTION We assessed proficiency (accuracy and intra- and intertest reproducibility) of smart quantitative sensation tests (smart QSTs) in subjects without and with diabetic sensorimotor polyneuropathy (DSPN). METHODS Technologists from 3 medical centers using different but identical QSTs independently assessed 6 modalities of sensation of the foot (or leg) twice in patients without (n = 6) and with (n = 6) DSPN using smart computer assisted QSTs. RESULTS Low rates of test abnormalities were observed in health and high rates in DSPN. Very high intraclass correlations were obtained between continuous measures of QSTs and neuropathy signs, symptoms, or nerve conductions (NCs). No significant intra- or intertest differences were observed. CONCLUSIONS These results provide proof of concept that smart QSTs provide accurate assessment of sensation loss without intra- or intertest differences useful for multicenter trials. Smart technology makes possible efficient testing of body surface area sensation loss in symmetric length-dependent sensorimotor polyneuropathies.
Collapse
Affiliation(s)
- Peter J Dyck
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA, 55905
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Cruz-Almeida Y, Fillingim RB. Can quantitative sensory testing move us closer to mechanism-based pain management? PAIN MEDICINE (MALDEN, MASS.) 2014; 15:61-72. [PMID: 24010588 PMCID: PMC3947088 DOI: 10.1111/pme.12230] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This review summarizes the scientific literature relating to the use of quantitative sensory testing (QST) for mechanism-based pain management. DESIGN A literature search was undertaken using PubMed and search terms including quantitative sensory testing, pain, chronic pain, response to treatment, outcome measure. SETTINGS AND PATIENTS Studies including QST in healthy individuals and those with painful disorders were reviewed. MEASURES Publications reported on QST methodological issues including associations among measures and reliability. We also included publications on the use of QST measures in case-control studies, their associations with biopsychosocial mechanisms, QST measures predicting clinical pain, as well as predicting and reflecting treatment responses. RESULTS Although evidence suggests that QST may be useful in a mechanism-based classification of pain, there are gaps in our current understanding that need to be addressed including making QST more applicable in clinical settings. There is a need for developing shorter QST protocols that are clinically predictive of various pain subtypes and treatment responses without requiring expensive equipment. Future studies are needed, examining the clinical predictive value of QST including sensitivity and specificity for pain classification or outcome prediction. These findings could enable third-party payers' reimbursement, which would facilitate clinical implementation of QST. CONCLUSIONS With some developments, QST could become a cost-effective and clinically useful component of pain assessment and diagnosis, which can further our progress toward the goal of mechanism-based personalized pain management.
Collapse
Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry & Behavioral Science, University of Florida, Gainesville, Florida, USA
| | | |
Collapse
|
19
|
Bakkers M, Faber CG, Peters MJH, Reulen JPH, Franssen H, Fischer TZ, Merkies ISJ. Temperature threshold testing: a systematic review. J Peripher Nerv Syst 2013; 18:7-18. [PMID: 23521638 DOI: 10.1111/jns5.12001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The diagnosis of small fiber neuropathy (SFN) has been recently defined as typical symptoms due to small nerve fiber dysfunction accompanied by reduced intra-epidermal nerve fiber density (IENFD) or abnormal temperature threshold testing (TTT). Guidelines have been published for the assessment of IENFD. However, international guidelines for TTT are lacking. This paper presents a systematic literature review on reported TTT methods and provides recommendations for its future use in studies evaluating patients. A total of 164 papers fulfilled pre-defined requirements and were selected for review. Over 15 types of instruments are currently being used with a variety of methodological approaches for location, stimulus application, and sensation qualities examined. Consensus is needed to standardize the use of TTT as a diagnostic and follow-up tool in patients.
Collapse
Affiliation(s)
- Mayienne Bakkers
- Department of Neurology Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
20
|
Backonja M“M, Attal N, Baron R, Bouhassira D, Drangholt M, Dyck PJ, Edwards RR, Freeman R, Gracely R, Haanpaa MH, Hansson P, Hatem SM, Krumova EK, Jensen TS, Maier C, Mick G, Rice AS, Rolke R, Treede RD, Serra J, Toelle T, Tugnoli V, Walk D, Walalce MS, Ware M, Yarnitsky D, Ziegler D. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain 2013; 154:1807-1819. [DOI: 10.1016/j.pain.2013.05.047] [Citation(s) in RCA: 376] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 04/21/2013] [Accepted: 05/29/2013] [Indexed: 01/18/2023]
|
21
|
North CE, Creighton SM, Smith ARB. A comparison of genital sensory and motor innervation in women with pelvic organ prolapse and normal controls including a pilot study on the effect of vaginal prolapse surgery on genital sensation: a prospective study. BJOG 2012; 120:193-199. [DOI: 10.1111/1471-0528.12083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 11/27/2022]
Affiliation(s)
- CE North
- Warrell Unit; St Mary's Hospital; Manchester UK
| | - SM Creighton
- Institute of Women's Health; University College; London UK
| | - ARB Smith
- Warrell Unit; St Mary's Hospital; Manchester UK
| |
Collapse
|
22
|
Vas PRJ, Rayman G. Validation of the modified LDIFlare technique: a simple and quick method to assess C-fiber function. Muscle Nerve 2012; 47:351-6. [PMID: 23169592 DOI: 10.1002/mus.23532] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In this study we validated a modified laser Doppler imager method (mLDIf) for assessing C-fiber function and compared it to the original (oLDIf). Both measure flare size in foot skin after heating, but the mLDIf uses 47°C (vs. 44°C), making it quicker and better suited for clinical use. METHODS To confirm that mLDIf assesses C-fiber function, 5 healthy controls (HC) were studied before and after local anesthesia (LA). Reproducibility and comparison with oLDIf was assessed in HC (n = 16). Finally, diabetes subjects with (DN(+), n = 10) and without (DN(-), n = 16) neuropathy were studied. RESULTS LA almost abolished the flare (9.3 ± 3.0 cm(2) vs. 1.7 ± 0.3 cm(2), P < 0.0001). mLDIf produced larger flares (9.9 ± 3.4 vs. 5.7 ± 2.3 cm(2), P < 0.0001), but correlated with oLDIf (r = 0.81, P < 0.001). mLDIf was reduced in DN(-) (6.8 ± 2.8 vs. HC, P = 0.003), markedly so in DN(+) (2.0 ± 1.1 vs. HC and DN(-), P < 0.0001). CONCLUSION The mLDIf is a quick, practical method for assessing C-fiber function in the clinical setting.
Collapse
Affiliation(s)
- Prashanth R J Vas
- Diabetes Research Centre, Ipswich Hospital NHS Trust, Suffolk IP4 5PD, UK
| | | |
Collapse
|
23
|
Jakovljević M, Mekjavić IB. Reliability of the method of levels for determining cutaneous temperature sensitivity. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2012; 56:811-821. [PMID: 21858645 DOI: 10.1007/s00484-011-0483-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 06/20/2011] [Accepted: 07/24/2011] [Indexed: 05/31/2023]
Abstract
Determination of the thermal thresholds is used clinically for evaluation of peripheral nervous system function. The aim of this study was to evaluate reliability of the method of levels performed with a new, low cost device for determining cutaneous temperature sensitivity. Nineteen male subjects were included in the study. Thermal thresholds were tested on the right side at the volar surface of mid-forearm, lateral surface of mid-upper arm and front area of mid-thigh. Thermal testing was carried out by the method of levels with an initial temperature step of 2°C. Variability of thermal thresholds was expressed by means of the ratio between the second and the first testing, coefficient of variation (CV), coefficient of repeatability (CR), intraclass correlation coefficient (ICC), mean difference between sessions (S1-S2diff), standard error of measurement (SEM) and minimally detectable change (MDC). There were no statistically significant changes between sessions for warm or cold thresholds, or between warm and cold thresholds. Within-subject CVs were acceptable. The CR estimates for warm thresholds ranged from 0.74°C to 1.06°C and from 0.67°C to 1.07°C for cold thresholds. The ICC values for intra-rater reliability ranged from 0.41 to 0.72 for warm thresholds and from 0.67 to 0.84 for cold thresholds. S1-S2diff ranged from -0.15°C to 0.07°C for warm thresholds, and from -0.08°C to 0.07°C for cold thresholds. SEM ranged from 0.26°C to 0.38°C for warm thresholds, and from 0.23°C to 0.38°C for cold thresholds. Estimated MDC values were between 0.60°C and 0.88°C for warm thresholds, and 0.53°C and 0.88°C for cold thresholds. The method of levels for determining cutaneous temperature sensitivity has acceptable reliability.
Collapse
|
24
|
Inert gas narcosis has no influence on thermo-tactile sensation. Eur J Appl Physiol 2011; 112:1929-35. [PMID: 21932070 DOI: 10.1007/s00421-011-2169-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 09/04/2011] [Indexed: 10/17/2022]
Abstract
Contribution of skin thermal sensors under inert gas narcosis to the raising hypothermia is not known. Such information is vital for understanding the impact of narcosis on behavioural thermoregulation, diver safety and judgment of thermal (dis)comfort in the hyperbaric environment. So this study aimed at establishing the effects of normoxic concentration of 30% nitrous oxide (N(2)O) on thermo-tactile threshold sensation by studying 16 subjects [eight females and eight males; eight sensitive (S) and eight non-sensitive (NS) to N(2)O]. Their mean (SD) age was 22.1 (1.8) years, weight 72.8 (15.3) kg, height 1.75 (0.10) m and body mass index 23.8 (3.8) kg m(-2). Quantitative thermo-tactile sensory testing was performed on forearm, upper arm and thigh under two experimental conditions: breathing air (air trial) and breathing normoxic mixture of 30% N(2)O (N(2)O trial) in the mixed sequence. Difference in thermo-tactile sensitivity thresholds between two groups of subjects in two experimental conditions was analysed by 3-way mixed-model analysis of covariance. There were no statistically significant differences in thermo-tactile thresholds either between the Air and N(2)O trials, or between S and NS groups, or between females and males, or with respect to body mass index. Some clinically insignificant lowering of thermo-tactile thresholds occurred only for warm thermo-tactile thresholds on upper arm and thigh. The results indicated that normoxic mixture of 30% N(2)O had no influence on thermo-tactile sensation in normothermia.
Collapse
|
25
|
Moloney NA, Hall TM, O'Sullivan TC, Doody CM. Reliability of thermal quantitative sensory testing of the hand in a cohort of young, healthy adults. Muscle Nerve 2011; 44:547-52. [PMID: 21826684 DOI: 10.1002/mus.22121] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2011] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The reliability of thermal quantitative sensory testing (QST) has yet to be fully established. In this study we investigated intra- and interrater reliability of thermal QST in a blinded manner. METHODS Two investigators recorded thermal detection and pain thresholds on the hand of 22 volunteers, twice on two occasions. Results were analyzed using descriptive statistics, intraclass correlation coefficients (ICCs), and coefficients of variation (CVs). RESULTS Mean intraindividual differences were small for all measures except cold pain thresholds. ICC values for intra- and interrater reliability were: cold detection, 0.27-0.55; warm detection, 0.33-0.69; and heat pain, 0.39-0.86. Cold pain yielded high ICC values (0.87-0.94), but also high CV (84.9-90.2%). CONCLUSIONS In young, healthy adults, thermal detection and heat pain thresholds of the hand demonstrated good reliability for group comparisons and individual analyses. Cold pain threshold measures may be suitable for group comparisons, but a large variance in the data limits individual analyses.
Collapse
Affiliation(s)
- Niamh A Moloney
- School of Public Health, Physiotherapy, and Population Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | | | | | | |
Collapse
|
26
|
Geber C, Klein T, Azad S, Birklein F, Gierthmühlen J, Huge V, Lauchart M, Nitzsche D, Stengel M, Valet M, Baron R, Maier C, Tölle T, Treede RD. Test-retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): a multi-centre study. Pain 2011; 152:548-556. [PMID: 21237569 DOI: 10.1016/j.pain.2010.11.013] [Citation(s) in RCA: 230] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 10/13/2010] [Accepted: 11/12/2010] [Indexed: 12/13/2022]
Abstract
Quantitative sensory testing (QST) is an instrument to assess positive and negative sensory signs, helping to identify mechanisms underlying pathologic pain conditions. In this study, we evaluated the test-retest reliability (TR-R) and the interobserver reliability (IO-R) of QST in patients with sensory disturbances of different etiologies. In 4 centres, 60 patients (37 male and 23 female, 56.4±1.9years) with lesions or diseases of the somatosensory system were included. QST comprised 13 parameters including detection and pain thresholds for thermal and mechanical stimuli. QST was performed in the clinically most affected test area and a less or unaffected control area in a morning and an afternoon session on 2 consecutive days by examiner pairs (4 QSTs/patient). For both, TR-R and IO-R, there were high correlations (r=0.80-0.93) at the affected test area, except for wind-up ratio (TR-R: r=0.67; IO-R: r=0.56) and paradoxical heat sensations (TR-R: r=0.35; IO-R: r=0.44). Mean IO-R (r=0.83, 31% unexplained variance) was slightly lower than TR-R (r=0.86, 26% unexplained variance, P<.05); the difference in variance amounted to 5%. There were no differences between study centres. In a subgroup with an unaffected control area (n=43), reliabilities were significantly better in the test area (TR-R: r=0.86; IO-R: r=0.83) than in the control area (TR-R: r=0.79; IO-R: r=0.71, each P<.01), suggesting that disease-related systematic variance enhances reliability of QST. We conclude that standardized QST performed by trained examiners is a valuable diagnostic instrument with good test-retest and interobserver reliability within 2days. With standardized training, observer bias is much lower than random variance. Quantitative sensory testing performed by trained examiners is a valuable diagnostic instrument with good interobserver and test-retest reliability for use in patients with sensory disturbances of different etiologies to help identify mechanisms of neuropathic and non-neuropathic pain.
Collapse
Affiliation(s)
- Christian Geber
- Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Germany Lehrstuhl für Neurophysiologie, CBTM, Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Germany Klinik für Neurologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Germany Abteilung Schmerztherapie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany Klinik für Neurologie, Technische Universität München, Germany Klinik für Anästhesie der Ludwig-Maximilians-Universität, München, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Guergova S, Dufour A. Thermal sensitivity in the elderly: a review. Ageing Res Rev 2011; 10:80-92. [PMID: 20685262 DOI: 10.1016/j.arr.2010.04.009] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 04/19/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
Abstract
Aging is associated with a progressive decrease in thermal perception, as revealed by increased thermal detection thresholds in the elderly. This reduction in thermosensitivity follows a distal-proximal pattern, with more pronounced decrements observed in the limbs and in the perception of warmth vs. cold. The main underlying causes of this seem to be aging of the skin and subsequent reductions in thermoreceptor density and superficial skin blood flow. However, the results from some animal studies also suggest that changes in the peripheral nerve system, particularly fiber loss and decreased conduction velocity, may also be involved. In this paper, we review age-related changes in the thermal sensitivity of humans, their underlying mechanisms, and the strengths and limitations of some of the methodologies used to assess these changes.
Collapse
|
28
|
Martin CL, Waberski BH, Pop-Busui R, Cleary PA, Catton S, Albers JW, Feldman EL, Herman WH. Vibration perception threshold as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: results from the DCCT/EDIC study. Diabetes Care 2010; 33:2635-41. [PMID: 20833868 PMCID: PMC2992204 DOI: 10.2337/dc10-0616] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the sensitivity, specificity, positive predictive value, and negative predictive value of vibration perception threshold (VPT) testing in subjects with type 1 diabetes relative to gold standard assessments of peripheral neuropathy. RESEARCH DESIGN AND METHODS VPT was determined in 1,177 adults with type 1 diabetes 13-14 years after participating in a study of intensive (INT) versus conventional (CONV) diabetes treatment. Abnormal VPT was defined by values exceeding 2.5 SD above age-specific normal values. Signs and symptoms of peripheral neuropathy were assessed and electrodiagnostic studies were performed to establish definite clinical neuropathy, abnormal nerve conduction, and confirmed clinical neuropathy (the presence of both definite clinical neuropathy and abnormal nerve conduction). RESULTS Thirty-seven percent of subjects had definite clinical neuropathy, 61% had abnormal nerve conduction, and 30% had confirmed clinical neuropathy. Abnormal VPT was more common among former CONV than among INT subjects (64 vs. 57%, P < 0.05) and was associated with older age. VPT was a sensitive measure of confirmed clinical neuropathy (87%) and of definite clinical neuropathy (80%) and a specific measure of abnormal nerve conduction (62%). Higher VPT cut points improved test sensitivity and lower cut points improved specificity. Areas under the receiver operating characteristic curves ranged from 0.71-0.83 and were higher for older than for younger subjects and highest for those with confirmed clinical neuropathy. CONCLUSIONS VPT was a sensitive measure of peripheral neuropathy. Future researchers may choose to select VPT cut points for defining abnormality based on the population studied and clinical outcome of interest.
Collapse
|
29
|
Moloney N, Hall T, Doody C. An investigation of somatosensory profiles in work related upper limb disorders: a case-control observational study protocol. BMC Musculoskelet Disord 2010; 11:22. [PMID: 20113518 PMCID: PMC2825226 DOI: 10.1186/1471-2474-11-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 01/30/2010] [Indexed: 11/25/2022] Open
Abstract
Background Work related upper limb disorders constitute 45% of all occupational diseases and are a significant public health problem. A subgroup, non specific arm pain (NSAP), remains elusive in terms of understanding its pathophysiological mechanisms with its diagnosis based on the absence of specific clinical findings. One commonly proposed theory is that a neural tissue disorder is the primary dysfunction in NSAP and findings from previous studies lend some support to this theory. However, it is not clear if changes identified are simply a consequence of ongoing pain rather than due to specific neural changes. The presence of neuropathic pain has been investigated in several other musculoskeletal conditions but currently, there is no specific diagnostic tool or gold standard which permits an unequivocal diagnosis of neuropathic pain. The purpose of this study is to further describe the somatosensory profiles in patients with NSAP and to compare these profiles to a group of patients with MRI confirmed cervical radiculopathy who have been previously classified as having neuropathic pain. Methods/Design Three groups of participants will be investigated: Groups 1 and 2 will be office workers with either NSAP or cervical radiculopathy and Group 3 will be a control group of non office workers without upper limb pain. Participants will undergo a clinical assessment, pain questionnaires (LANSS, Short Form McGill, DASH and TSK) and quantitative sensory testing comprising thermal detection and pain thresholds, vibration thresholds and pressure pain thresholds. Discussion The spectrum of clinically suspected neuropathic pain ranges from more obvious conditions such as trigeminal neuralgia to those with vague signs of nerve disorder such as NSAP. A thorough description of the somatosensory profiles of NSAP patients and a comparison with a more defined group of patients with evidence of neuropathic pain will help in the understanding of underlying neurophysiology in NSAP and may influence future classification and intervention studies relating to this condition.
Collapse
Affiliation(s)
- Niamh Moloney
- UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | | | | |
Collapse
|
30
|
Falder S, Browne A, Edgar D, Staples E, Fong J, Rea S, Wood F. Core outcomes for adult burn survivors: A clinical overview. Burns 2009; 35:618-41. [PMID: 19111399 DOI: 10.1016/j.burns.2008.09.002] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 09/02/2008] [Indexed: 11/25/2022]
|
31
|
Krishnan STM, Quattrini C, Jeziorska M, Malik RA, Rayman G. Abnormal LDIflare but normal quantitative sensory testing and dermal nerve fiber density in patients with painful diabetic neuropathy. Diabetes Care 2009; 32:451-5. [PMID: 19074993 PMCID: PMC2646027 DOI: 10.2337/dc08-1453] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Abnormal small nerve fiber function may be an early feature of diabetic neuropathy and may also underlie painful symptoms. Methods for assessing small-fiber damage include quantitative sensory testing (QST) and determining intraepidermal nerve fiber density. We recently described a reproducible physiological technique, the LDIflare, which assesses small-fiber function and thus may reflect early dysfunction before structural damage. The value of this technique in painful neuropathy was assessed by comparing it with QST and dermal nerve fiber density (NFD). RESEARCH DESIGN AND METHODS Fifteen healthy control subjects, 10 subjects with type 2 diabetes and painful neuropathy (PFN), and 12 subjects with type 2 diabetes and painless neuropathy (PLN) were studied. LDIflare and QST were performed on the dorsum of the foot, and dermal NFD was determined. RESULTS Results of both large- and small-fiber quantitative sensory tests were abnormal in patients with PLN but not those with PFN compared with control subjects. Dermal NFD was also significantly reduced in the PLN group compared with control subjects (205.8 +/- 165.3 vs. 424.9 +/- 176.3 [mean +/- SD]; P = 0.003) but not in the PFN group (307.6 +/- 164.5). In contrast, the LDIflare (square centimeters) was reduced in both PFN (1.59 +/- 0.41) and PLN (1.51 +/- 0.56) groups compared with control subjects (4.38 +/- 1.4) (P < 0.001 for both). NFD correlated significantly with the LDIflare (r = 0.57, P < 0.0001). CONCLUSIONS The LDIflare demonstrated impaired small-fiber function in patients with PFN when other assessments revealed no abnormality. We believe that this method has potential diagnostic value, particularly because it is noninvasive, has excellent reproducibility, and correlates with NFD. Furthermore, it may have an important role in assessing preventative therapies in early neuropathy.
Collapse
|
32
|
Dahlin LB, Thrainsdottir S, Cederlund R, Thomsen NOB, Eriksson KF, Rosén I, Speidel T, Sundqvist G. Vibrotactile sense in median and ulnar nerve innervated fingers of men with Type 2 diabetes, normal or impaired glucose tolerance. Diabet Med 2008; 25:543-9. [PMID: 18346156 DOI: 10.1111/j.1464-5491.2008.02433.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To investigate vibrotactile sense (large fibre neuropathy) at different frequencies in index and little fingers (median and ulnar nerves, respectively) of subjects with diabetes, or impaired (IGT) or normal glucose tolerance (NGT). METHODS Vibration thresholds (tactilometry at seven frequencies (8, 16, 32, 64, 125, 250 and 500 Hz)) and median nerve function (electrophysiology) were examined in men (age 73.4 +/- 0.12 years; n = 58, mean +/- sd) with persistent NGT (n = 28) or IGT (n = 7) or with Type 2 diabetes mellitus (T2DM) (n = 23) for > 15 years. RESULTS HbA1c was increased and vibrotactile sense (sensibility index) was impaired in index and little fingers in men with T2DM. Vibration thresholds were particularly increased at 16, 250 and 500 Hz in the little finger (ulnar nerve). T2DM subjects showed electrophysiological (gold standard) signs of neuropathy in the median nerve. Although subjects with persistent IGT had higher HbA1c, vibrotactile sensation and electrophysiology remained normal. HbA1c did not correlate with vibrotactile sense or electrophysiology, but the latter two correlated with respect to Z-score (sign of neuropathy) in forearm (NGT) and at wrist level (NGT and DM). CONCLUSIONS Vibration thresholds are increased in the finger pulps in T2DM subjects, particularly at specific frequencies in ulnar nerve innervated finger pulps. Neuropathy is not present in IGT. Tactilometry, with a multi-frequency approach, is a sensitive technique to screen for large fibre neuropathy in T2DM. Frequency-related changes may mirror dysfunction of various receptors.
Collapse
Affiliation(s)
- L B Dahlin
- Department of CLinical Sciences in Malmö (Hand Surgery), Malmö University Hospital, Lund University, Malmö, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Thermal perception thresholds among young adults exposed to hand-transmitted vibration. Int Arch Occup Environ Health 2008; 81:519-33. [DOI: 10.1007/s00420-007-0258-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Accepted: 09/05/2007] [Indexed: 11/26/2022]
|
34
|
Duke J, McEvoy M, Sibbritt D, Guest M, Smith W, Attia J. Vibrotactile threshold measurement for detecting peripheral neuropathy: defining variability and a normal range for clinical and research use. Diabetologia 2007; 50:2305-12. [PMID: 17846743 DOI: 10.1007/s00125-007-0813-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 07/23/2007] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS We aimed to define normal ranges for vibration sense as measured by vibratory perception thresholds (VPTs) using biothesiometry. METHODS We performed biothesiometry in a community-dwelling sample of 901 people aged 55 to 85 years who did not have diabetes. We quantitated the variation between repeat measures using analysis of variance and Bland-Altman plots. We also plotted the age- and sex-specific reference ranges. RESULTS We found small but statistically significant differences between repeat measures using the ascending and descending method of limits. Statistically higher vibration thresholds were noted on the right arm and leg compared with the left. Significantly higher vibration thresholds were also seen in men vs women for both lower limbs. We also defined sex-specific reference intervals (normal ranges) for biothesiometry for older persons and quantitated the increase in vibration threshold with increasing age. CONCLUSIONS/INTERPRETATION For reliability, it may be sufficient to obtain the average of two ascending measures separated by at least 1 min in just the right hand or right foot, since this is usually the one with the higher threshold. Although identical reference ranges can be used for men and women for the upper limb, there are significant differences in the lower limbs. The major determinant of VPT is age: we have established age-specific norms for VPT testing for adults between 55 and 85 years of age.
Collapse
Affiliation(s)
- J Duke
- Centre for Clinical Epidemiology and Biostatistics, David Maddison Building, University of Newcastle, Newcastle, New South Wales, Australia
| | | | | | | | | | | |
Collapse
|
35
|
Bird SJ, Brown MJ, Spino C, Watling S, Foyt HL. Value of repeated measures of nerve conduction and quantitative sensory testing in a diabetic neuropathy trial. Muscle Nerve 2006; 34:214-24. [PMID: 16708368 DOI: 10.1002/mus.20577] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Conduct of a large, multicenter trial of the aldose reductase inhibitor zenarestat provided data on the reproducibility of multiple electrophysiologic (nerve conduction studies, NCS) and quantitative sensory (QST) tests. Baseline and 12-month electrophysiologic data from approximately 1100 patients at multiple centers were available for analysis. Intersite variability contributed minimally to overall test variance. All NCS tests were highly reproducible. Cool thermal and vibration QST thresholds, as measured by CASE IV instrumentation, were also highly reproducible. Intersubject variance accounted for the majority of variance for all parameters measured. Repeating NCS and QST measures decreased sample sizes needed to show statistical significance. Consideration of these observations, particularly with regard to QST, should aid in the design of future clinical trials investigating neuropathy.
Collapse
Affiliation(s)
- Shawn J Bird
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | | |
Collapse
|
36
|
Caselli A, Spallone V, Marfia GA, Battista C, Pachatz C, Veves A, Uccioli L. Validation of the nerve axon reflex for the assessment of small nerve fibre dysfunction. J Neurol Neurosurg Psychiatry 2006; 77:927-32. [PMID: 16624842 PMCID: PMC2077635 DOI: 10.1136/jnnp.2005.069609] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 03/14/2006] [Accepted: 03/26/2006] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To validate nerve-axon reflex-related vasodilatation as an objective method to evaluate C-nociceptive fibre function by comparing it with the standard diagnostic criteria. METHODS Neuropathy was evaluated in 41 patients with diabetes (26 men and 15 women) without peripheral vascular disease by assessing the Neuropathy Symptom Score, the Neuropathy Disability Score (NDS), the vibration perception threshold (VPT), the heat detection threshold (HDT), nerve conduction parameters and standard cardiovascular tests. The neurovascular response to 1% acetylcholine (Ach) iontophoresis was measured at the forearm and at both feet by laser flowmetry. An age-matched and sex-matched control group of 10 healthy people was also included. RESULTS Significant correlations were observed between the neurovascular response at the foot and HDT (r(s) = -0.658; p<0.0001), NDS (r(s) = -0.665; p<0.0001), VPT (r(s) = -0.548; p = 0.0005), tibial nerve conduction velocity (r(s) = 0.631; p = 0.0002), sural nerve amplitude (r(s) = 0.581; p = 0.0002) and autonomic function tests. According to the NDS, in patients with diabetes who had mild, moderate or severe neuropathy, a significantly lower neurovascular response was seen at the foot than in patients without neuropathy and controls. A neurovascular response <50% was found to be highly sensitive (90%), with a good specificity (74%), in identifying patients with diabetic neuropathy. CONCLUSION Small-fibre dysfunction can be diagnosed reliably with neurovascular response assessment. This response is already reduced in the early stages of peripheral neuropathy, supporting the hypothesis that small-fibre impairment is an early event in the natural history of diabetic neuropathy.
Collapse
Affiliation(s)
- A Caselli
- Department of Internal Medicine, University of Tor Vergata, Viale Oxford, 81 00133 Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
37
|
Sorensen L, Molyneaux L, Yue DK. The Level of Small Nerve Fiber Dysfunction Does not Predict Pain in Diabetic Neuropathy: A Study Using Quantitative Sensory Testing. Clin J Pain 2006; 22:261-5. [PMID: 16514326 DOI: 10.1097/01.ajp.0000169670.47653.fb] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether small nerve fiber dysfunction predicts pain in diabetic neuropathy using quantitative sensory testing of thermal thresholds. METHODS Diabetic patients with or without painful neuropathy (n=191) were studied. Small nerve fiber function was assessed by quantitative sensory testing of cold detection and heat pain thresholds. Subjects were also categorized as being hyperalgesic (<10th percentile) or hyposensitive (>90th percentile) by comparing with normative data. Vibration perception threshold, a large nerve fiber function, was measured using a biothesiometer (Bio-medical Instrument, Newbury, OH). RESULTS In the patients with pain, cold stimulus was detected after a greater reduction in temperature from baseline (-3.7 degrees C vs. -0.6 in the no-pain group, P<0.0001). There were no differences between the pain and painless groups in the heat pain tests, with hyperalgesia noted in about 60% of subjects. Vibration perception threshold and loss of ankle reflexes were significant determinants of pain, but together they accounted for only 6.8% of the variance. If these were removed from the model, cold detection threshold became a significant determinant of pain but accounted for only 3.0% of the variance. CONCLUSIONS Quantitative sensory testing of small nerve fiber function is a useful test to detect the presence of neuropathy, and overall diabetic patients with neuropathic pain have more sensory loss. However, small nerve fiber abnormalities detected by quantitative sensory testing do not predict the presence of pain in diabetic neuropathy.
Collapse
Affiliation(s)
- Lea Sorensen
- Diabetes Centre, Royal Prince Alfred Hospital Sydney, Australia Discipline of Medicine, University of Sydney, Australia.
| | | | | |
Collapse
|
38
|
Connell K, Guess MK, La Combe J, Wang A, Powers K, Lazarou G, Mikhail M. Evaluation of the role of pudendal nerve integrity in female sexual function using noninvasive techniques. Am J Obstet Gynecol 2005; 192:1712-7. [PMID: 15902183 DOI: 10.1016/j.ajog.2004.12.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Using quantitative sensory testing and a validated questionnaire, we investigated the role of pudendal nerve integrity in sexual function among women. STUDY DESIGN Participants completed the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ). Vibratory and pressure thresholds were measured at the S2 dermatome reflecting pudendal nerve distribution. RESULTS A total of 56 women enrolled; 29 (51.8%) were asymptomatic and 27 (48.2%) had 1 or more forms of female sexual dysfunction (total sexual dysfunction) including: desire disorder 16.1%, arousal disorder 26.8%, orgasmic disorder 25%, and pain disorder 12.5%. Age, parity, menopausal status, and body mass index were similar between groups. PISQ scores were lower in symptomatic subjects compared with controls (P < .001). Decreased tactile sensation was found at the clitoris for women with total sexual dysfunction, desire disorder, and arousal disorder. Women with arousal disorder also had decreased tactile sensation at the perineum. CONCLUSION Pudendal nerve integrity may play a role in female sexual dysfunction.
Collapse
Affiliation(s)
- Kathleen Connell
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
| | | | | | | | | | | | | |
Collapse
|
39
|
Essick G, Guest S, Martinez E, Chen C, McGlone F. Site-dependent and subject-related variations in perioral thermal sensitivity. Somatosens Mot Res 2005; 21:159-75. [PMID: 15763901 DOI: 10.1080/08990220400012414] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Marstock method of limits was used to obtain thresholds for detection of cooling, warming, cold pain and heat pain for 34 young adults, upon eight spatially matched sites on the left and right sides of the face, the right ventral forearm and the scalp. Male and female subjects were tested by both a male and a female experimenter. Neither the experimenter nor the gender of the subject individually influenced the thresholds. The thermal thresholds varied greatly across facial sites: sixfold and tenfold for cool and warmth, respectively, from the most sensitive sites on the vermilion to the least sensitive facial site, the preauricular skin. Warm thresholds were 68% higher than cool thresholds, on average, and 12% higher on the left compared to the right side of the face. The mean cold pain threshold increased from 21.0 degrees C on the hairy upper lip to 17.8 degrees C on the preauricular skin. Sites on the upper lip were also most sensitive to noxious heat with pain thresholds of 42-43 degrees C. The scalp was notably insensitive to innocuous and noxious changes in temperature. For the sensations of nonpainful cool and warmth, the more sensitive a site, the less the estimates of the thresholds differed between subjects. In contrast, for heat pain, the more sensitive a site, the more the estimates differed between subjects. Subjects who were relatively more sensitive to cool tended to be relatively more sensitive to warmth. Subjects' sensitivities to nonpainful cool and warmth were less predictive of their sensitivities to painful cold and heat, respectively. Short-term within-subject variability increased with the magnitude of the thresholds. The lower the threshold, the more similar were repeated measurements of it, within a 5-25 s period.
Collapse
Affiliation(s)
- Greg Essick
- Department of Prosthodontics, University of North Carolina, Chapel Hill, NC 27599, USA
| | | | | | | | | |
Collapse
|
40
|
Krishnan STM, Rayman G. The LDIflare: a novel test of C-fiber function demonstrates early neuropathy in type 2 diabetes. Diabetes Care 2004; 27:2930-5. [PMID: 15562209 DOI: 10.2337/diacare.27.12.2930] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate a novel method for assessing the axon reflex and to determine its value in detecting neuropathy in type 2 diabetes. RESEARCH DESIGN AND METHODS The neurogenic flare response to nociceptive stimuli is mediated by an axon reflex involving small unmyelinated C-fibers. We developed a method to assess this reflex involving skin heating to 44 degrees C to evoke the flare followed by scanning the site using a laser Doppler imager (LDI) to measure the area; we termed this method LDIflare. To confirm its neurogenic nature, we examined the LDIflare in eight healthy subjects before and after topical administration of anesthesia. We used this technique to detect C-fiber neuropathy in people with type 2 diabetes. A total of 36 subjects were studied: 12 subjects with neuropathy (group DN), 12 subjects without neuropathy (group DC), and 12 age- and sex-matched control subjects (group NC). For comparison, small-fiber function was also assessed using the Computer Aided Sensory Evaluator-IV (CASE IV) (WR Medical Electronics, Stillwater, MN). RESULTS In the eight healthy control subjects, LDIflare was markedly reduced after topical administration of anesthesia (1.62 [1.45-1.72] vs. 5.2 cm2 [3.9-5.9], P <0.0001), confirming its neurogenic nature. Similarly, in neuropathic subjects, LDIflare was significantly smaller compared with normal and diabetic control subjects (LDIflare area: DN 1.3 cm2 [0.9-1.8], NC 5.5 cm2 [3.9-5.8], and DC 2.8 cm2 [2.5-3.8]; P <0.0001 and P=0.01, respectively). The group without neuropathy (DC) also demonstrated a reduced flare compared with the NC group (P=0.01). In contrast, C-fiber function assessed by evaluating the quantitative thermal thresholds (CASE IV) did not detect a difference between the latter two groups. CONCLUSIONS This study confirms the neurogenic nature of the LDIflare and clearly demonstrates loss of C-fiber function in neuropathic subjects with type 2 diabetes. Moreover, it demonstrates C-fiber dysfunction before its detection by other currently available methods, including CASE IV. The LDIflare seems to be a simple objective method to detect early neuropathy and may be of value in assessing therapeutic interventions aimed at preventing or reversing C-fiber dysfunction.
Collapse
Affiliation(s)
- Singhan T M Krishnan
- FRCP, The Ipswich Diabetes Centre, Ipswich Hospital NHS Trust, Heath Road, Ipswich, UK
| | | |
Collapse
|
41
|
Cata JP, Weng HR, Dougherty PM. Cyclooxygenase inhibitors and thalidomide ameliorate vincristine-induced hyperalgesia in rats. Cancer Chemother Pharmacol 2004; 54:391-7. [PMID: 15235822 DOI: 10.1007/s00280-004-0809-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2003] [Accepted: 03/02/2004] [Indexed: 10/26/2022]
Abstract
In this study ibuprofen (50.0 mg/kg, i.p.), rofecoxib (10.0 mg/kg, i.p.) and thalidomide (50.0 mg/kg, oral) were shown to prevent vincristine-induced mechanical hyperalgesia. Sprague-Dawley rats were injected every other day with vincristine (0.1 mg/kg) over 13 days. The animals were cotreated daily with vehicle (saline), ibuprofen, rofecoxib or thalidomide throughout the period of vincristine treatment. Mechanical withdrawal threshold to punctuate and radiant heat stimuli were determined prior to and then on alternate days throughout the treatment period. Vincristine vehicle-treated animals developed marked mechanical hyperalgesia from day 5 of chemotherapy and this lasted until the end of the experiment. Thermal thresholds were not altered by the administration of vincristine vehicle. Animals in the vincristine vehicle group neither gained nor lost weight during the treatment period. All three active drugs showed an antihyperalgesic effect on the responses to mechanical stimulation of the hind paw that was significant from day 5 for ibuprofen and thalidomide and from day 7 for rofecoxib. Thermal thresholds increased after the administration of both the NSAIDs and thalidomide. Rofecoxib was the only drug to show any beneficial effect in protecting the animals from failure to gain body weight.
Collapse
Affiliation(s)
- J P Cata
- Department of Symptom Research, The Division of Anesthesiology and Critical Care Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, PO Box 42, Houston 77030, USA
| | | | | |
Collapse
|
42
|
Affiliation(s)
- Andrew J M Boulton
- Division of Endocrinology, University of Miami School of Medicine, P.O. Box 016960 (D-110), Miami, Florida, USA.
| | | | | | | |
Collapse
|
43
|
Connell K, Guess MK, Bleustein CB, Powers K, Lazarou G, Mikhail M, Melman A. Effects of age, menopause, and comorbidities on neurological function of the female genitalia. Int J Impot Res 2004; 17:63-70. [PMID: 15164089 DOI: 10.1038/sj.ijir.3901230] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to investigate the effects of age, menopause, and comorbidities on neurological function of the female genitalia using a noninvasive, validated technique. In all, 58 consecutive women were enrolled in the study. Biothesiometry was performed at five genital sites and one peripheral site with S2 dermatome distribution. Kruskal-Wallis one-way ANOVA on ranks was used to evaluate the relationship between age and vibratory sensation. Bivariate and regressional analyses were performed to evaluate the effects of age, menopause and comorbidities on genital sensation. The mean age was 44.6+14.8 y (range 20-78 y). Vibration thresholds increased with advancing age at all six sites. Multilinear regression analysis indicated that menopause and increasing age negatively affect sensation. History of herniated lumbar disc, vaginal delivery, and diabetes variably affected genital sensation. There is a significant increase in vibration thresholds (indicating worsening neurological function) in women as they age and undergo menopause. Biothesiometry is a technique for evaluating genital neurological function in women with coexisting morbidities.
Collapse
Affiliation(s)
- K Connell
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
| | | | | | | | | | | | | |
Collapse
|
44
|
Brown MJ, Bird SJ, Watling S, Kaleta H, Hayes L, Eckert S, Foyt HL. Natural progression of diabetic peripheral neuropathy in the Zenarestat study population. Diabetes Care 2004; 27:1153-9. [PMID: 15111537 DOI: 10.2337/diacare.27.5.1153] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to report the baseline and natural progression of diabetic peripheral neuropathy over 12 months in a large mild-to-moderate neuropathy population. RESEARCH DESIGN AND METHODS Patients from a multicentered trial of zenarestat, an aldose reductase inhibitor, had serial measures of neurologic function, including nerve conduction studies (NCSs), quantitative sensory testing (QST), and clinical neuropathy rating scores at baseline and at 12 months. Baseline population descriptors and changes in neurologic function in placebo-treated patients were analyzed. RESULTS Sural sensory velocity (P = 0.0008 [95% CI -1.04 to -0.27]), median sensory amplitude (P = 0.0021 [-1.3 to -0.29]), median distal motor latency (P = 0.002 [0.09-0.28]), cool thermal QST (P = 0.0005 [0.27-0.94]), and Michigan Neuropathy Screening Instrument results (P = 0.0087 [0.04-0.30]) declined significantly from baseline in the placebo population. NCS changes from baseline were independent of baseline HbA1c stratification. CONCLUSIONS The neurologic decline over 12 months is evident when measured by NCS and cool thermal QST. Other measures (vibration QST, neuropathy rating scores, monofilament examination) are insensitive to changes over 12 months in a mild-to-moderate affected population of this size.
Collapse
Affiliation(s)
- Mark J Brown
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Diabetic sensorimotor polyneuropathy (DSP) is the most common complication of diabetes. In order to manage DSP effectively, it is necessary to formulate an accurate diagnosis and monitor subjects regularly. This review of important aspects of the diagnosis of DSP starts with a conceptual framework that includes elements of DSP epidemiology, pathophysiology, and therapy. The emphasis of the review is to present our current understanding of diagnostic methods for DSP including their utility and limitations. Screening for DSP in the diabetes clinic can be achieved successfully using simple clinical tests. Clinical neurophysiological methods are necessary to exclude other diagnoses, stage severity, and monitor the course of DSP. Novel investigative techniques are highly promising, but their usefulness in the clinic setting remains limited at this time. This article presents an overview of diagnostic methods for DSP.
Collapse
Affiliation(s)
- Bruce A Perkins
- EN 11-209, TGH, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4
| | | |
Collapse
|
46
|
Bleustein CB, Arezzo JC, Eckholdt H, Melman A. The neuropathy of erectile dysfunction. Int J Impot Res 2002; 14:433-9. [PMID: 12494274 DOI: 10.1038/sj.ijir.3900907] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2002] [Accepted: 05/15/2002] [Indexed: 11/08/2022]
Abstract
These studies were intended to explore the relationship between autonomic neuropathy and erectile dysfunction (ED). Sensory thresholds reflecting the integrity of both large diameter, myelinated neurons (ie pressure, touch, vibration) and small diameter axons (ie hot and cold thermal sensation) were determined on the penis and finger. Data were compared across subjects with and without ED, controlling for age, hypertension and diabetes. The correlation of specific thresholds scores and IIEF values were also examined. Seventy-three patients who visited the academic urology clinics at Montefiore hospital were evaluated. All patients were required to complete the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire: 20 subjects had no complaints of ED and scored within the 'normal' range on the IIEF. Patients were subsequently tested on their index finger and glans penis for vibration (Biothesiometer), pressure (Semmes-Weinstein monofilaments), spatial perception (Tactile Circumferential Discriminator), and warm and cold thermal thresholds (Physitemp NTE-2). Sensation of the glans penis, as defined by the examined sensory thresholds, was significantly diminished in patients with ED and these differences remained significant when controlling for age, diabetes and hypertension. In contrast, thresholds on the index finger were equivalent in the ED and non-ED groups. Threshold and IIEF scores were highly correlated, consistent with an association between diminished sensation and decreasing IIEF score (worse erectile functioning). These relations also remained significant when controlling for age, diabetes and hypertension. The findings demonstrate dysfunction of large and small diameter nerve fibers in patients with ED of all etiologies. Further, the neurophysiologic measures validate the use of the IIEF as an index of ED, as objective findings of sensory neuropathy were highly correlated with worse IIEF scores. The sensory threshold methods utilized represent novel, non-invasive and relatively simple procedures, which can be used in a longitudinal fashion to assess a patient's neurological response to therapies.
Collapse
Affiliation(s)
- C B Bleustein
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
| | | | | | | |
Collapse
|
47
|
Hwu CM, Chang HY, Chen JY, Wang SL, Ho LT, Pan WH. Quantitative vibration perception thresholds in normal and diabetic chinese: influence of age, height and body mass index. Neuroepidemiology 2002; 21:271-8. [PMID: 12411729 DOI: 10.1159/000065526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In this study, we established normality data of vibration perception thresholds (VPT) in a Chinese population. Over 1,400 healthy subjects were recruited to create age-related centile charts of VPT after pretesting for reliability. Another 273 diabetic (DM) patients were recruited to assess the impact of age, height and body mass index (BMI) on VPT values in DM and non-DM subjects. The present study is the first one which reports normality data of VPT from a large Chinese population. The VPT values were higher in male and female DM patients than in the non-DM counterparts. Age significantly contributed to the variance of VPT in both DM and non-DM subjects. Height was positively associated with VPT in men, so was BMI in non-DM subjects with much smaller magnitudes of effect than for age.
Collapse
Affiliation(s)
- Chii-Min Hwu
- Section of General Medicine, Department of Medicine, Taipei Veterans General Hospital,Taipei, Taiwan, ROC
| | | | | | | | | | | |
Collapse
|
48
|
Bril V, Perkins BA. Comparison of vibration perception thresholds obtained with the Neurothesiometer and the CASE IV and relationship to nerve conduction studies. Diabet Med 2002; 19:661-6. [PMID: 12147147 DOI: 10.1046/j.1464-5491.2002.00759.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Vibration perception thresholds (VPTs) are used frequently to assess somatosensory pathways in clinical trials. Different equipment, testing paradigms, and stimulation sites produce varying results which make comparisons between trials and patient populations challenging. Information comparing the VPT obtained with the Neurothesiometer with that with the Vibratron is available, but not for a similar comparison with the CASE IV (computer-assisted sensory examination device). METHODS Subjects (n = 478) including reference, non-neuropathic subjects with diabetes mellitus (DM), and diabetic patients with mild, moderate and severe diabetic sensorimotor polyneuropathy (DSP) had VPTs measured with the CASE IV and Neurothesiometer, as well as standard sural nerve conduction studies (NCS), all performed during the same half-day. The dorsum of the foot was used as the site of stimulation for the CASE IV VPT determination and the distal phalanx of the first toe for the Neurothesiometer. RESULTS VPTs by the CASE IV and the Neurothesiometer compared moderately by linear regression analyses (R2 = 0.547, P < 0.0001), and by 95% confidence intervals. Sensitivity for the diagnosis of mild DSP was 70% with the Neurothesiometer and 49% with the CASE IV. VPTs determined by either the Neurothesiometer or the CASE IV correlated with similar agreement to the sural nerve action potential amplitude as determined by nerve conduction studies (NCS) (R2 = 0.456 and 0.461, respectively, P < 0.0001). CONCLUSIONS The results demonstrated a significant correlation of VPT values in different stages of DSP obtained by the two methods. The Neurothesiometer was more sensitive for the diagnosis of DSP, particularly in those with mild neuropathy. Similar correlations between VPTs and electrophysiological parameters were observed, indicating that both methods are valid, and thus the Neurothesiometer may be preferable due to the ease and rapidity of testing by this method.
Collapse
Affiliation(s)
- Vera Bril
- Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4.
| | | |
Collapse
|
49
|
Liu W, Lipsitz LA, Montero-Odasso M, Bean J, Kerrigan DC, Collins JJ. Noise-enhanced vibrotactile sensitivity in older adults, patients with stroke, and patients with diabetic neuropathy. Arch Phys Med Rehabil 2002; 83:171-6. [PMID: 11833019 DOI: 10.1053/apmr.2002.28025] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the hypothesis that vibrotactile detection thresholds in older adults, patients with stroke, and patients with diabetic neuropathy can be significantly reduced with the introduction of mechanical noise. DESIGN A randomized controlled study. SETTING A university research laboratory. PARTICIPANTS Twelve healthy elderly subjects (age range, 67-85y), 5 patients with stroke (age range, 24-64y), and 8 patients with diabetic neuropathy (age range, 53-77y). INTERVENTIONS Each subject's detection thresholds (ie, minimum level of stimulus to be detected) for a vibrotactile stimulus without and with mechanical noise (ie, random vibration with a small intensity) were determined by using a 4-, 2-, and 1-stepping algorithm. The stimuli were applied to the fingertip and/or to the first metatarsal of the foot. MAIN OUTCOME MEASURE Detection threshold for a vibrotactile stimulus. RESULTS The detection threshold at the fingertip for the vibration stimulus with mechanical noise was significantly lower than that without mechanical noise for all 12 elderly subjects, for 4 of the 5 patients with stroke, and all 8 patients with diabetic neuropathy. For the 8 patients with diabetes, mechanical noise also significantly reduced the vibrotactile detection threshold at the foot. CONCLUSIONS Reduced vibrotactile sensitivity in older adults, patients with stroke, and patients with diabetic neuropathy can be significantly improved with input mechanical noise. Noise-based techniques and devices may prove useful in overcoming age- and disease-related losses in sensorimotor function.
Collapse
Affiliation(s)
- Wen Liu
- Center for BioDynamics and Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | | | | | | | | | | |
Collapse
|
50
|
Hagander LG, Midani HA, Kuskowski MA, Parry GJ. Quantitative sensory testing: effect of site and pressure on vibration thresholds. Clin Neurophysiol 2000; 111:1066-9. [PMID: 10825714 DOI: 10.1016/s1388-2457(00)00278-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the effect of different sites and locally applied pressure on vibration thresholds. METHODS Vibration thresholds were compared in 47 normal volunteers at 3 sites of the index finger (pulp, dorsum of the middle phalanx and nail) and at two sites of the great toe (dorsum of the proximal phalanx and nail). The effect of local pressure (30, 50 and 100 g/1.22 cm(2)) were compared in 41 subjects at the dorsum of the middle phalanx of the index finger and the proximal phalanx of the great toe. RESULTS The hand was more sensitive than the foot for vibration. There were no significant differences in vibration thresholds at different sites of the index finger and different sites of the great toe. The pulp of the index finger yielded the least inter-individual variation. Testing under 30 and 50 g/1.22 cm(2) of pressure yielded equal vibration thresholds. Vibration threshold was higher when tested under 100 g/1.22 cm(2) at the index finger but not the great toe. This difference was small and clinically negligible. CONCLUSION Testing of vibration thresholds in normal subjects can be adequately conducted at several sites of the index finger and the great toe. The test can be adequately done under low pressure of 30-50 g/1.22 cm(2).
Collapse
Affiliation(s)
- L G Hagander
- Department of Neurology, Fairview University Medical Center, University of Minnesota, 420 Delaware Street S.E., MN, 55455, Minneapolis, USA
| | | | | | | |
Collapse
|