L’allodynie mécanique masque une hypoesthésie : observations topographiques de 23 patients douloureux neuropathiques chroniques

Abstract

L'étiologie des allodynies mécaniques est sujette à la controverse. Dans cette recherche, 25 allodynies mécaniques stastiques (AMS), traitées par rééducation sensitive (n = 23 patients), ont été étudiées topographiquement : les AMS cartographiées (allodynographies) rétrécis-sent en surface. Leur mode de disparition successif a été cartographié, ainsi que l'apparition de leur hypoesthésie. Le centre de la cartographie de la dernière AMS se situe en regard du centre de la dernière cartographie de son hypoesthésie (esthésiographie secondaire) : 9,7 mm en moyenne AE ET = 8,0 (étendue : 1-38 mm). Nous concluons que l'AMS disparaît vers le centre de son hypoesthésie. En présence d'une hypersensibilité au toucher, cette observation devrait aider le clinicien à identifier l'étiologie du nerf cutané lésé.Abstract: The aetiology of mechanical allodynia is still controversial. In the present study, we investigated the precise locations of 25 static mechanical allodynias (SMA) treated by somatosensory rehabilitation (n = 23 patients): the allodynic territory mapped (allodynography) was seen to shrink. The mode of progressive regression and finally disappearance of the SMA was mapped, as was the hypoaesthesia. The center of the final SMA map is aligned with the center of the final hypoaesthesia map (secondary aesthesiography): the inter-center distance was on average 9.7 mm AE SD = 8.0 (range: 1-38 mm). We conclude that the SMA disappears in the direction of the centre of the underlying hypoaesthesia. In cases of hypersensitivity to touch, this observation should help the physician identify the damaged cutaneous nerve.

Allodynography: Reliability of a New Procedure for Objective Clinical Examination of Static Mechanical Allodynia

“…A positive allodynography, combined with the formation of clinical neuroanatomic hypothesis, meets the diagnostic standards for a probable diagnosis of neuropathic pain [14]. In the SRM, the ability to identify underlying somatosensory tactile hypoesthesia (termed a positive secondary aesthesiography) [13,19] after reduction and total resolution of the mapped allodynia provides a form of criterion validation: the pathognomonic hypoesthesia of a nerve lesion is only unmasked by resolution of the allodynia [13,16,29]. The reliability of this standardized clinical examination procedure adds to previous validation work [13,16] and creates a foundation for further explorations of validity, such as comparison with other forms of screening for neuropathic pain [30].…”

“…For an objective clinical examination procedure to have utility as a diagnostic indicator, it requires three psychometric properties: validity, reliability, and responsiveness to change [15]. The validity of allodynography to diagnose Ab axonal lesions has already received some preliminary examination [13,16]. From these findings, it can be postulated that patients report symptoms of neuropathic pain because of lesions of the Ab fibers of a cutaneous nerve branch [17,18].…”

Somatosensory rehabilitation for allodynia in complex regional pain syndrome of the upper limb: A retrospective cohort study

“…The assessment protocol was completed as follows: (1) QDSA and allodynography at the first/baseline visit; (2) rainbow pain scale on first subsequent visit; (3) repeat evaluation of QDSA and allodynography every 4 weeks, or sooner if indicated; and (4) esthesiography (mapping of the underlying area of tactile hypoesthesia) 21,22 and quantitative somatosensory testing including static 2-point discrimination, vibration perception threshold, and pressure perception threshold when the allodynography is negative (15 g stimulus to the skin is not perceived as painful) for 2 consecutive visits. The QDSA, static 2-point discrimination, vibration perception threshold, and pressure perception threshold were also recorded at discharge.…”

“…15 Although the clinical application of somatosensory rehabilitation method (SRM) has been well described in nonepeer-reviewed literature, 15,20 to date, there have only been a few peer-reviewed articles focusing on the effectiveness of the technique with specific populations, addressing both allodynia and hypoesthesia across a spectrum of nerve lesions. [21][22][23] Given the need for clinical modalities to address the allodynia that limits both activities of daily living and participation in rehabilitation for persons with CRPS, this study will seek to evaluate the clinical results of the SRM for this population.…”

Protocolos de reabilitação na dor neuropática: revisão bibliométrica

“…Nesses casos, pode ser recomendada a prescrição de "não toque", para que esse local da pele tenha o mínimo de contato possível com o meio externo. Recomenda-se uma equipe multidisciplinar para abranger todos os aspectos biopsicossociais do paciente, afetados pela lesão física primária25 . Os artigos com tratamento não farmacológico na área da Fisioterapia precisam ser voltados para o paciente como um todo, abrangendo contexto biopsicossocial, QV, níveis de atividade física e custos com o tratamento.…”