Faculté de Médecine, Université Paris Est Créteil, EA 4391, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, et Médecine du Sport, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Bobigny, France.
Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France; Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
Clin Neurophysiol. 2014 May;125(5):1048-58. doi: 10.1016/j.clinph.2013.09.038. Epub 2013 Oct 28.
To characterize sensory threshold alterations in peripheral neuropathies and the relationship between these alterations and the presence of pain.
Seventy-four patients with length-dependent sensory axonal neuropathy were enrolled, including 38 patients with painful neuropathy (complaining of chronic, spontaneous neuropathic pain in the feet) and 36 patients with painless neuropathy. They were compared to 28 age-matched normal controls. A standardized quantitative sensory testing protocol was performed in all individuals to assess large and small fiber function at the foot. Large fibers were assessed by measuring mechanical (pressure and vibration) detection thresholds and small fibers by measuring pain and thermal detection thresholds.
Between patients with neuropathy and controls, significant differences were found for mechanical and thermal detection thresholds but not for pain thresholds. Patients with painful neuropathy and those with painless neuropathy did not differ regarding mechanical or thermal thresholds, but only by a higher incidence of thermal or dynamic mechanical allodynia in case of painful neuropathy. Pain intensity correlated with the alteration of thermal detection and mechanical pain thresholds.
Quantitative sensory testing can support the diagnosis of sensory neuropathy when considering detection threshold measurement. Thermal threshold deterioration was not associated with the occurrence of pain but with its intensity.
There is a complex relationship between the loss or functional deficit of large and especially small sensory nerve fibers and the development of pain in peripheral neuropathy.
描述周围神经病变的感觉阈值改变以及这些改变与疼痛存在之间的关系。
共纳入 74 例长度依赖性感觉轴索性神经病患者，包括 38 例伴痛性神经病（足部慢性自发性神经性疼痛）患者和 36 例无痛性神经病患者。将他们与 28 名年龄匹配的正常对照进行比较。所有个体均进行标准化定量感觉测试方案，以评估足部的大纤维和小纤维功能。通过测量机械（压力和振动）检测阈值来评估大纤维，通过测量疼痛和热检测阈值来评估小纤维。
与对照组相比，神经病患者的机械和热检测阈值存在显著差异，但疼痛阈值无差异。伴痛性神经病和无痛性神经病患者的机械或热阈值无差异，但伴痛性神经病患者仅表现为热或动态机械性痛觉过敏的发生率更高。疼痛强度与热检测和机械疼痛阈值的改变相关。
当考虑检测阈值测量时，定量感觉测试可支持感觉性神经病的诊断。热阈值恶化与疼痛的发生无关，而与疼痛强度有关。
在周围神经病中，大纤维尤其是小感觉神经纤维的丧失或功能缺陷与疼痛的发生之间存在复杂的关系。
