A standard test of heat-pain responses using CASE IV

Dyck, Peter James; Zimmerman, I. R.; Johnson, David M.; Gillen, D. A.; Hokanson, J. L.; Karnes, Jeannine L.; Gruener, Gregory; O’Brien, Peter C.

doi:10.1016/0022-510x(95)00277-9

Cited by 93 publications

(91 citation statements)

References 23 publications

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“…Patients in these two groups underwent quantitative sensory tests (CASE IV). For the diagnosis of neuropathy, patients were required to have a cold detection threshold or heat-to-pain threshold Ͼ90% (22,23). Absence of neuropathy was defined by normal findings during standardized neurological examination and normal values in quantitative sensory testing (i.e., a cold detection threshold or heat-to-pain threshold Ͻ75%.…”

Section: Methodsmentioning

confidence: 99%

Local Sympathetic Denervation in Painful Diabetic Neuropathy

et al. 2002

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This study assessed whether painful diabetic neuropathy is associated with abnormal sympathetic nervous function in the affected limbs. Nine patients with diabetes (four men, five women; age 61 ؎ 7 years) and painful peripheral neuropathy of the feet, but without evidence of generalized autonomic neuropathy, underwent intravenous infusion of tritiated norepinephrine (NE) and sampling of arterial and venous blood in both feet and in one arm to quantify the rate of entry of NE into the local venous plasma (NE spillover). In the same patients, positron emission tomography (PET) scanning after intravenous injection of the sympathoneural imaging agent 6-[18 F]fluorodopamine was used to visualize sympathetic innervation and after intravenous [13 N]ammonia to visualize local perfusion. The results were compared with those in the feet of normal volunteers and in an unaffected foot of patients with unilateral complex regional pain syndrome (CRPS). In addition, neurochemical results obtained in painful diabetic neuropathy were compared with those obtained in diabetic control patients with painless neuropathy and diabetic control patients without neuropathy. Local arteriovenous difference in plasma NE levels (⌬NE AV ) and NE spillover in the arms did not differ across the groups. However, ⌬NE AV in the feet was significantly less in the group with painful diabetic neuropathy than in the control groups. Also NE spillover in the feet tended to be lower in painful neuropathy. ⌬NE AV of diabetic control patients without neuropathy (n ‫؍‬ 6) resembled values in the control groups without diabetes, whereas patients with painless diabetic neuropathy (n ‫؍‬ 6) had evidence suggesting partial loss of sympathetic innervation. PET scanning revealed decreased flow-corrected 6-[18 F]fluorodopamine-derived radioactivity in patients with painful diabetic neuropathy, compared with values in normal volunteers and patients with CRPS. The results provide neurochemical and neuroimaging evidence for regionally selective sympathetic denervation in the painful feet of patients with diabetic neuropathy.

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Section: Methodsmentioning

confidence: 99%

Local Sympathetic Denervation in Painful Diabetic Neuropathy

et al. 2002

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“…Measurements were taken 2 cm proximal to the sites of skin biopsies, on the nondominant limb. VDT was performed on the nondominant foot using the Computer-Aided Sensory Evaluator IV device, according to previously published methods and algorithms (22)(23)(24)(25)(26).…”

Section: Efficacy Measurementsmentioning

confidence: 99%

A 6-Month, Randomized, Double-Masked, Placebo-Controlled Study Evaluating the Effects of the Protein Kinase C-β Inhibitor Ruboxistaurin on Skin Microvascular Blood Flow and Other Measures of Diabetic Peripheral Neuropathy

et al. 2007

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OBJECTIVE -Diabetes leads to protein kinase C (PKC)-␤ overactivation and microvascular dysfunction, possibly resulting in disordered skin microvascular blood flow (SkBF) and other changes observed in diabetic peripheral neuropathy (DPN) patients. We investigate the effects of the isoform-selective PKC-␤ inhibitor ruboxistaurin mesylate on neurovascular function and other measures of DPN.RESEARCH DESIGN AND METHODS -Endothelium-dependent and C fibermediated SkBF, sensory symptoms, neurological deficits, nerve fiber morphometry, quantitative sensory and autonomic function testing, nerve conduction studies, quality of life (using the Norfolk Quality-of-Life Questionnaire for Diabetic Neuropathy [QOL-DN]), and adverse events were evaluated for 20 placebo-and 20 ruboxistaurin-treated (32 mg/day) DPN patients (aged Ն18 years; with type 1 or type 2 diabetes and A1C Յ11%) during a randomized, doublemasked, single-site, 6-month study.RESULTS -Endothelium-dependent (ϩ78.2%, P Ͻ 0.03) and C fiber-mediated (ϩ56.4%, P Ͻ 0.03) SkBF at the distal calf increased from baseline to end point. Significant improvements from baseline within the ruboxistaurin group were also observed for the Neuropathy Total Symptom Score-6 (NTSS-6) (3 months Ϫ48.3%, P ϭ 0.01; end point Ϫ66.0%, P Ͻ 0.0006) and the Norfolk QOL-DN symptom subscore and total score (end point Ϫ41.2%, P ϭ 0.01, and Ϫ41.0, P ϭ 0.04, respectively). Between-group differences in baseline-to-end point change were observed for NTSS-6 total score (placebo Ϫ13.1%; ruboxistaurin Ϫ66.0%, P Ͻ 0.03) and the Norfolk QOL-DN symptom subscore (placebo Ϫ4.0%; ruboxistaurin Ϫ41.2%, P ϭ 0.041). No significant ruboxistaurin effects were demonstrated for the remaining efficacy measures. Adverse events were consistent with those observed in previous ruboxistaurin studies.CONCLUSIONS -In this cohort of DPN patients, ruboxistaurin enhanced SkBF at the distal calf, reduced sensory symptoms (NTSS-6), improved measures of Norfolk QOL-DN, and was well tolerated. Diabetes Care 30:896 -902, 2007

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“…However, it has also been reported that there exists an influence of the baseline temperature on heat pain threshold and heat pain ratings to a constant-temperature heat stimulator (Tillman et al 1995a,b;Dyck et al 1996;Nielsen & Arendt-Nielsen 1998a,b;Pertovaara 1999;Wu et al 2001). Tillman et al (1995a,b) demonstrated that the threshold temperature at the skin surface for initiating action potentials in CMHs in the monkey decreases as the baseline skin temperature is increased.…”

Section: (Iii) Influence Of Baseline Temperaturementioning

confidence: 99%

A multi-scale view of skin thermal pain: from nociception to pain sensation

Zhu

2010

Phil. Trans. R. Soc. A.

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All biological bodies live in a thermal environment, including the human body, where skin is the interface with a protecting function. When the temperature is out of the normal physiological range, skin fails to protect, and the pain sensation is evoked. Furthermore, in medicine, with advances in laser, microwave and similar technologies, various thermal therapeutic methods have been widely used to cure disease/injury involving skin tissue. However, the corresponding problem of pain relief has limited further application and development of these thermal treatments. Skin thermal pain is induced through both direct (i.e. an increase/decrease in temperature) and indirect (e.g. thermomechanical and thermochemical) ways, and is governed by complicated thermomechanical-chemicalneurophysiological responses. However, a complete understanding of the underlying mechanisms is still far from clear. In this article, starting from an engineering perspective, we aim to recast the biological behaviour of skin in engineering system parlance. Then, by coupling the concepts of engineering with established methods in neuroscience, we attempt to establish multi-scale modelling of skin thermal pain through ion channel to pain sensation. The model takes into account skin morphological plausibility, the thermomechanical response of skin tissue and the biophysical and neurological mechanisms of pain sensation.

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A standard test of heat-pain responses using CASE IV

Cited by 93 publications

References 23 publications

Local Sympathetic Denervation in Painful Diabetic Neuropathy

Local Sympathetic Denervation in Painful Diabetic Neuropathy

A 6-Month, Randomized, Double-Masked, Placebo-Controlled Study Evaluating the Effects of the Protein Kinase C-β Inhibitor Ruboxistaurin on Skin Microvascular Blood Flow and Other Measures of Diabetic Peripheral Neuropathy

A multi-scale view of skin thermal pain: from nociception to pain sensation

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