Chapter 26 Clinical examination

Scadding, John W

doi:10.1016/s0072-9752(06)80030-8

Cited by 5 publications

(1 citation statement)

References 49 publications

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“…Somatosensory information from the skin to the central nervous system is conveyed via sensory nerve fibres, including thinly myelinated (Aδ) and unmyelinated (C) nerve fibres. Damage to these nerve fibres gives rise to peripheral neuropathies, including small‐fibre neuropathy (SFN; Scadding, ). As the name suggests, it is primarily or exclusively the small nerve fibres that are affected in SFN, some of which are painful and some are pain free (Tavee and Zhou, ).…”

Section: Introductionmentioning

confidence: 99%

Structural and functional assessment of skin nerve fibres in small‐fibre pathology

Karlsson

Nyengaard

Polydefkis

et al. 2014

European Journal of Pain

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Damage to nociceptor nerve fibres may give rise to peripheral neuropathies, some of which are pain free and some are painful. A hallmark of many peripheral neuropathies is the loss of small nerve fibres in the epidermis, a condition called small-fibre neuropathy (SFN) when it is predominantly the small nerve fibres that are damaged. Historically, SFN has been very difficult to diagnose as clinical examination and nerve conduction studies mainly detect large nerve fibres, and quantitative sensory testing is not sensitive enough to detect small changes in small nerve fibres. However, taking a 3-mm punch skin biopsy from the distal leg and quantification of the nerve fibre density has proven to be a useful method to diagnose SFN. However, the correlation between the nerve fibre loss and other test results varies greatly. Recent studies have shown that it is possible not only to extract information about the nerve fibre density from the biopsies but also to get an estimation of the nerve fibre length density using stereology, quantify sweat gland innervation and detect morphological changes such as axonal swelling, all of which may be additional parameters indicating diseased small fibres relating to symptoms reported by the patients. In this review, we focus on available tests to assess structure and function of the small nerve fibres, and summarize recent advances that have provided new possibilities to more specifically relate structural findings with symptoms and function in patients with SFN.

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Section: Introductionmentioning

confidence: 99%

Structural and functional assessment of skin nerve fibres in small‐fibre pathology

Karlsson

Nyengaard

Polydefkis

et al. 2014

European Journal of Pain

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Assessment of Neuropathic Pain in Primary Care

Haanpää

Backonja

Bennett

et al. 2009

The American Journal of Medicine

195

115

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The evidence for pharmacological treatment of neuropathic pain

Finnerup

Sindrup

Jensen

2010

Pain

947

645

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Randomized, double-blind, placebo-controlled trials on neuropathic pain treatment are accumulating, so an updated review of the available evidence is needed. Studies were identified using MEDLINE and EMBASE searches. Numbers needed to treat (NNT) and numbers needed to harm (NNH) values were used to compare the efficacy and safety of different treatments for a number of neuropathic pain conditions. One hundred and seventy-four studies were included, representing a 66% increase in published randomized, placebo-controlled trials in the last 5 years. Painful poly-neuropathy (most often due to diabetes) was examined in 69 studies, postherpetic neuralgia in 23, while peripheral nerve injury, central pain, HIV neuropathy, and trigeminal neuralgia were less often studied. Tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, the anticonvulsants gabapentin and pregabalin, and opioids are the drug classes for which there is the best evidence for a clinical relevant effect. Despite a 66% increase in published trials only a limited improvement of neuropathic pain treatment has been obtained. A large proportion of neuropathic pain patients are left with insufficient pain relief. This fact calls for other treatment options to target chronic neuropathic pain. Large-scale drug trials that aim to identify possible subgroups of patients who are likely to respond to specific drugs are needed to test the hypothesis that a mechanism-based classification may help improve treatment of the individual patients.

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Chapter 26 Clinical examination

Cited by 5 publications

References 49 publications

Structural and functional assessment of skin nerve fibres in small‐fibre pathology

Structural and functional assessment of skin nerve fibres in small‐fibre pathology

Assessment of Neuropathic Pain in Primary Care

The evidence for pharmacological treatment of neuropathic pain

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