Pain Insensitivity Syndrome Misinterpreted as Inflicted Burns

Bosch, Gerbrich van den; Baartmans, Martin; Vos, Paul; Dokter, J.; White, Tonya; Tibboel, Dick

doi:10.1542/peds.2013-2015

Cited by 27 publications

(19 citation statements)

References 13 publications

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“…In previous QST studies at our department we used the same standardized TSA-II test protocol to determine detection- and pain thresholds [10, 16]. The protocol is structured as follows: explaining the procedure to the subject in less than a minute, determining visual-motor reaction time since one of the QST subtests is reaction time dependent (2–3 min) [15], determining detection- and pain thresholds using the reaction time dependent Method of Limits (MLI) (8–10 min), and determining detection thresholds using the reaction time independent Method of Levels (MLE) (4–5 min).…”

Section: Methodsmentioning

confidence: 99%

“…The non-dominant hand was chosen so as to allow the subject to use the dominant hand for clicking the button during the MLI subtest. Detection thresholds were measured with two methods, MLI and MLE, as these are both commonly used in the literature [7, 10–12, 16, 17]. Furthermore, a previous study in 5-year-old children demonstrated significant differences between both methods in which the MLE established more sensitive detection thresholds compared to the MLI [10].…”

Section: Methodsmentioning

confidence: 99%

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Thermal quantitative sensory testing in healthy Dutch children and adolescents standardized test paradigm and Dutch reference values

et al. 2017

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BackgroundQuantitative sensory testing (QST) is often used to measure children’s and adults’ detection- and pain thresholds in a quantitative manner. In children especially the Thermal Sensory Analyzer (TSA-II) is often applied to determine thermal detection and pain thresholds. As comparisons between studies are hampered by the different testing protocols used, we aimed to present a standard protocol and reference values for thermal detection- and pain thresholds in children.MethodsOur standard testing protocol includes reaction time dependent and independent tests and takes about 14–18 min to complete. Reference values were obtained from a sample of 69 healthy term born children and adolescents with a median age of 11.2 years (range 8.2 to 17.9 years old). Seventy-one children were recruited and data of 28 males and 41 females was obtained correctly. We studied possible age and sex differences.ResultsThis study provides Dutch reference values and presents a standard quantitative sensory testing protocol for children with an age from 8 years onwards. This protocol appeared to be feasible, since only two out of 71 participants were not able to correctly complete the protocol due to attention deficits and were therefore excluded. We found some significant age and sex differences: females were statistically significantly more sensitive for both cold and heat pain compared to males, and the youngest children (8–9 years old) were less sensitive to detect a warm stimulus. The youngest children tend to be more sensitive to heat pain in comparison to older participants, although the difference was not statistically significant.ConclusionsWe present a feasible thermal quantitative sensory testing protocol for children and reference values that are easy to interpret and may serve as normative values for future studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0827-7) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Thermal quantitative sensory testing in healthy Dutch children and adolescents standardized test paradigm and Dutch reference values

et al. 2017

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“…Detection thresholds were measured using both the reaction time-dependent method of limits and the reaction time-independent method of levels. For more details, see van den Bosch et al [20]. …”

Section: Methodsmentioning

confidence: 99%

Prematurity, Opioid Exposure and Neonatal Pain: Do They Affect the Developing Brain?

Bosch¹,

White

Marroun

et al. 2015

Neonatology

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Background: Traditionally, 10 years ago, children born preterm often routinely received morphine, especially during mechanical ventilation. Studies in neonatal rats, whose stage of brain development roughly corresponds to that of children born preterm, found negative long-term effects after pain and opioid exposure. Objectives: We studied possible effects of prematurity, procedural pain and opioids in humans 10 years later. We hypothesized that these factors would negatively influence neurobiological, neuropsychological and sensory development later in life. Methods: We included 19 children born preterm who as neonates participated in an RCT on the short-term effects of morphine administration and who previously participated in our follow-up studies at ages 5 and 8/9 years. We assessed associations between brain morphology (n = 11), neuropsychological functioning (n = 19) and thermal sensitivity (n = 17) and prematurity, opioid exposure and neonatal pain. Results: Significant correlations (coefficients 0.60-0.85) of gestational age, number of painful procedures and morphine exposure with brain volumes were observed. Significant correlations between these factors and thermal sensitivity were not established. Neuropsychological outcome was significantly moderately correlated with morphine exposure in only two subtests, and children performed in general ‘average' by Dutch norms. Conclusions: Although prematurity, opioid exposure and neonatal pain were significantly associated with brain volume, no major associations with neuropsychological functioning or thermal sensitivity were detected. Our findings suggest that morphine administration during neonatal life does not affect neurocognitive performance or thermal sensitivity during childhood in children born preterm without brain damage during early life. Future studies with larger sample sizes are needed to confirm these findings.

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“…Insensitivity to pain can lead to various complications such as infection, ulceration and sometimes death [2].…”

Section: Discussionmentioning

confidence: 99%

Congenital insensitivity to pain syndrome accompanied by neglected orthopedic traumas and complications

et al. 2017

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Pain is a protective mechanism. Congenital insensitivity to pain syndrome is a very rare disease in which there is no ability to feel physical pain. It has been reported that it occurs with an incidence of 1 in 125 million newborn. Patients with congenital insensitivity to pain may have various orthopedic complications such as recurrent fractures, osteomyelitis and neuropathic joints. The most frequently affected body parts are lower extremities. Besides, curvature of spine can be seen. Injuries in epiphyseal points may cause incompatibility of extremity. Charcot joints may develop, which can lead to neuropathic arthropathy as a result of insensitivity to pain. Here, we present a patient with traumatic fracture-dislocation on left hip that neglected the treatment, had a bilateral femur fracture and then had septic arthritis of knee.

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Pain Insensitivity Syndrome Misinterpreted as Inflicted Burns

Cited by 27 publications

References 13 publications

Thermal quantitative sensory testing in healthy Dutch children and adolescents standardized test paradigm and Dutch reference values

Thermal quantitative sensory testing in healthy Dutch children and adolescents standardized test paradigm and Dutch reference values

Prematurity, Opioid Exposure and Neonatal Pain: Do They Affect the Developing Brain?

Congenital insensitivity to pain syndrome accompanied by neglected orthopedic traumas and complications

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