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CHEPs could be utilized as a tool to evaluate the
pathophysiology of small-fibre sensory nerve as it showed better performance
than thermal thresholds.
Neuropathy means nerve disease or damage.Symptoms can range
from numbness or tingling, to pricking sensations (paresthesia), or muscle
weakness. Areas of the body may become abnormally sensitive leading to an
exaggeratedly intense or distorted experience of touch (allodynia). In such
cases, pain may occur in response to a stimulus that does not normally provoke
pain. Severe symptoms may include burning pain (especially at night), muscle
wasting, paralysis, or organ or gland dysfunction. Damage to nerves that supply
internal organs may impair digestion, sweating, sexual function, and urination.
Different biomarkers are used for estimating neuropathy of small nerve fibres
like the histamine-induced skin flare response and intra-epidermal fibres
(IEF),contact heat evoked potential (CHEP) and quantitative sensory testing
(QST).Among these biomarkers,
Contact heat-evoked potentials (CHEPs) have become a promising procedure for assessing small-fiber sensory nerves.It's potential as a physiological signature of neuropathic pain symptoms has not been fully determined.
A total of 188 patients (115
men) with length-dependent sensory symptoms and reduced intraepidermal nerve
fiber (IENF) density at the distal leg were enrolled to perform CHEP,
quantitative sensory testing, and nerve conduction study so that the diagnostic
efficacy in examining small-fiber sensory nerve degeneration, its relationship
with skin innervations, and clinical correlates with sensory symptoms can be
evaluated. Fifty-seven age- and sex-matched controls were enrolled for
comparison of CHEP and skin innervation. Among patients with neuropathy, 144
patients had neuropathic pain and 64 cases had evoked pain. CHEP amplitudes
showed the highest sensitivity for diagnosing small-fiber sensory nerve
degeneration and exhibited the strongest correlation with IENF density in
multiple linear regression as compared with quantitative sensory testing and
nerve conduction study parameters. Contact heat-evoked potential amplitudes
were strongly correlated with the degree of skin innervation in both patients
with neuropathy and controls. The slope of the regression line between CHEP
amplitude and IENF density was higher in patients with neuropathy than in
controls. Patients with evoked pain had higher CHEP amplitude than those without
evoked pain,which was independent of
IENF density. Receiver operating characteristic analysis remarked that CHEP had
better performance in diagnosing small-fiber sensory nerve degeneration than
thermal thresholds.CHEPs showed superior classification accuracy with respect
to evoked pain. At last it was interpretated that CHEP appears as a sensitive
tool to evaluate pathophysiology of small-fiber sensory nerve and serves as a
physiological signature of neuropathic pain symptoms.
Pain
Biomarkers of neuropathic pain in skin nerve regeneration neuropathy;contact heat evoked potentials as a physioogical signature.
Wu, Shao-Wei et al.
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