Sensory profiles in women with neuropathic pain after breast cancer surgery.

PURPOSE: We performed a detailed analysis of sensory function in patients with chronic post-surgical neuropathic pain (NP) after breast cancer treatments by quantitative sensory testing (QST) with DFNS (German Research Network on Neuropathic Pain) protocol and bed side examination (BE). The nature of sensory changes in peripheral NP may reflect distinct pathophysiological backgrounds that can guide the treatment choices. NP with sensory gain (i.e., hyperesthesia, hyperalgesia, allodynia) has been shown to respond to Na+-channel blockers (e.g., oxcarbazepine). METHODS: 104 patients with at least "probable" NP in the surgical area were included. All patients had been treated for breast cancer 4-9 years ago and the handling of the intercostobrachial nerve (ICBN) was verified by the surgeon. QST was conducted at the site of NP in the surgical or nearby area and the corresponding contralateral area. BE covered the upper body and sensory abnormalities were marked on body maps and digitalized for area calculation. The outcomes of BE and QST were compared to assess the value of QST in the sensory examination of this patient group. RESULTS: Loss of function in both small and large fibers was a prominent feature in QST in the area of post-surgical NP. QST profiles did not differ between spared and resected ICBN. In BE, hypoesthesia on multiple modalities was highly prevalent. The presence of sensory gain in BE was associated with more intense pain. CONCLUSIONS: Extensive sensory loss is characteristic for chronic post-surgical NP several years after treatment for breast cancer. These patients are unlikely to respond to Na+-channel blockers.

Distemper Encephalomyelitis Presenting with Lower Motor Neuron Signs in a Young Dog.

A 4 mo old spayed female mixed-breed dog was presented for focal lower motor neuron signs of the right forelimb and marked hyperesthesia on axillary palpation. Her signs progressed rapidly over the following days to diffuse lower motor neuron signs in all limbs and a seizure. MRI demonstrated a focal, slightly right-sided, 2.5 cm region of noncontrast-enhancing T2 hyperintensity and T1 isointensity at C4-C5 spinal cord segments. Imaging of the brain was unremarkable. The dog was euthanized as a result of poor prognosis. Polymerase chain reaction on cerebrospinal fluid and immunohistochemistry of brain tissue were both positive for canine distemper virus. This report documents an atypical presentation of canine distemper encephalomyelitis causing lower motor neuron signs and hyperesthesia.

Sensitive Skin Syndrome: An Update.

Sensitive skin syndrome is a widely reported complaint but a diagnostic challenge because of its subjective symptoms and lack of clearly visible manifestations. Epidemiological studies have shown the prevalence of sensitive skin to be as high as 60-70% among women and 50-60% among men. Patients with this syndrome usually have unpleasant sensations when exposed to physical, thermal, or chemical stimuli that normally cause no provocation on healthy skin. Recent studies and newly accepted position papers have provided a more in-depth understanding and consensus of its underlying pathophysiology, associations, diagnosis, and treatment. Since no clinical studies have been conducted about specific treatment protocols, patients with this condition should be provided with personalized skin management. Given this updated knowledge, our review offers an approach to sensitive skin syndrome, with differential diagnoses, and interventions targeting its pathophysiology.

Dermoid sinus type VI associated with spina bifida and tethered cord syndrome in a French Bulldog.

A 4-mo-old French bulldog was presented with acute onset pain and reluctance to move. A tubular structure arising in the dorsal thoracic midline and extending from a cutaneous orifice into deeper tissues was palpated on physical examination. Computed tomography with sinography revealed a dermoid sinus associated with spina bifida at the level of T3-T4. On surgical exploration, the dermoid sinus was found to communicate with the dura. Histology confirmed the diagnosis and classification as a type VI dermoid sinus. The pain response and hyperesthesia were suspected to be the result of tethered cord syndrome. Complete resolution of clinical signs was appreciated post-surgery, with the patient still free of clinical signs 3 mo later.

Sleep Shortage Is Associated With Postherpetic Neuralgia Development Through Hyperesthesia and Acute Pain Intensity: A Community-Based Prospective Cohort Study.

OBJECTIVES: There have been no community-based studies investigating the association between sleep duration and postherpetic neuralgia (PHN) development. The aim of the current study was to examine the association of sleep with herpes zoster (HZ) incidence and PHN. METHODS: In total, 12,329 residents (ages 50 to 103 years) of Shozu County, Japan, participated in our study from December 2009 to November 2010 and were followed up for 3 years. At baseline, the participants completed self-administered health questionnaires, including those on usual sleep duration. Three dermatologists diagnosed HZ on the basis of clinical symptoms and virus identification testing by polymerase chain reaction and serological tests, and evaluated pain using a modified Zoster Brief Pain Inventory survey form via telephone. We used a Cox proportional hazard regression model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HZ and PHN. We also performed mediation analysis to examine whether hyperesthesia and acute pain intensity mediated the association between sleep shortage and chronic pain intensity. RESULTS: During follow-up, 400 cases of HZ were identified. Of these, 55 participants developed PHN. Sleep duration was not associated with HZ incidence. Sleep shortage increased the risk for PHN (HR 2.02 [95% CI: 1.06 to 3.85]). Hyperesthesia and acute pain intensity mediated the association between sleep shortage and chronic pain intensity (indirect/total effect ratio = 50% mediation). CONCLUSIONS: Sleep shortage was associated with increased risk for PHN, and hyperesthesia and acute pain intensity appeared to mediate this association. Sleep shortage may be a novel risk factor for PHN.

Feline hyperaesthesia syndrome with self-trauma to the tail: retrospective study of seven cases and proposal for an integrated multidisciplinary diagnostic approach.

CASE SERIES SUMMARY: This was a retrospective study on the clinical features and response to treatment in seven cats with feline hyperaesthesia syndrome (FHS) and tail mutilation. FHS is a poorly understood disorder characterised by skin rippling over the dorsal lumbar area, episodes of jumping and running, excessive vocalisation, and tail chasing and self-trauma. The majority of the cats were young, with a median age of 1 year at the onset of clinical signs, male (n = 6) and with access to the outdoors (n = 5). Multiple daily episodes of tail chasing and self-trauma were reported in five cats, with tail mutilation in four cats. Vocalisation during the episodes (n = 5) and rippling of lumbar skin (n = 5) were also reported. Haematology, serum biochemistry, Toxoplasma gondii and feline immunodeficiency virus/feline leukaemia virus serology, MRI scans of brain, spinal cord and cauda equina, cerebrospinal fluid analysis and electrodiagnostic tests did not reveal any clinically significant abnormalities. A definitive final diagnosis was not reached in any of the cats, but hypersensitivity dermatitis was suspected in two cases. A variety of medications was used alone or in combination, including gabapentin (n = 6), meloxicam (n = 4), antibiotics (n = 4), phenobarbital (n = 2), prednisolone (n = 2) and topiramate (n = 2); ciclosporin, clomipramine, fluoxetine, amitriptyline and tramadol were used in one cat each. Clinical improvement was achieved in six cases; in five cats complete remission of clinical signs was achieved with gabapentin alone (n = 2), a combination of gabapentin/ciclosporin/amitriptyline (n = 1), gabapentin/prednisolone/phenobarbital (n = 1) or gabapentin/topiramate/meloxicam (n = 1). RELEVANCE AND NOVEL INFORMATION: This is the first retrospective study on a series of cats with FHS. The diagnostic work-up did not reveal any significant abnormalities of the central or peripheral nervous system; dermatological and behavioural problems could not be ruled out. We propose an integrated multidisciplinary diagnostic pathway to be used for the management of clinical cases and for future prospective studies.

Skin surface lipid differences in sensitive skin caused by psychological stress and distinguished by support vector machine.

BACKGROUND: Sensitive skin refers to skin that tends to be highly responsive to stimuli such as physical, chemical, and psychological. Psychological factors play an important role in the pathology of sensitive skin. OBJECTIVE: This study investigated lipid difference between sensitive skin caused by psychological stress and normal skin, followed by construction of a support vector machine (SVM). METHODS: A noninvasive method was used to collect lipid samples from the skin surface. Ultra-performance liquid chromatography quadrupole time of flight mass spectrometry (UPLC-Q-TOF-MS) technique and partial least squares-discriminant analysis (PLS-DA) was used to screen for differential lipids. A correlation analysis was performed on differential lipids, and a support vector model was established based on the differential lipids. RESULTS: Twelve differential lipids were obtained, and the most differentiating species were triacylglycerols (TGs), followed by monounsaturated fatty acids (MUFAs), saturated fatty acids (SFAs), diacylglycerols (DGs), and 6-hydroxysphingosine levels. Triglyceride, SFA, and MUFA species showed a high correlation, and the support vector machine (SVM) differentiation model based on differential lipids had a 100% accuracy rate. CONCLUSION: Psychological stress may cause damage to the permeability and antimicrobial barriers of the skin, thereby resulting in sensitive skin. Differentiation models based on SVMs have good prospects for distinguishing sensitive skin caused by psychological stress.

Anti-hypersensitive effect of angiotensin (1-7) on streptozotocin-induced diabetic neuropathic pain in mice.

BACKGROUND: We have recently reported that the spinal angiotensin (Ang) converting enzyme (ACE)/Ang II/AT1 receptor axis and downstream p38 MAPK phosphorylation are activated in streptozotocin (STZ)-induced diabetic mice and lead to tactile hypersensitivity. Moreover, our previous results suggested that the intrathecal (i.t.) administration of Ang (1-7), an N-terminal fragment of Ang II, may attenuate the Ang II-induced nociceptive behaviour through the inhibition of p38 MAPK phosphorylation via Mas receptors. Here, we investigated whether the i.t. administration of Ang (1-7) can attenuate STZ-induced diabetic neuropathic pain. METHODS: Tactile and thermal hypersensitivities were determined using the von Frey filament and Hargreaves tests, respectively. The protein expression of ACE2, Mas receptors and phospho-p38 MAPK was measured by western blotting. Spinal ACE2 activity was determined using ACE2 activity assay kit. RESULTS: The i.t. administration of Ang (1-7) significantly reduced the tactile and thermal hypersensitivities on day 14 after STZ injection, and these effects were significantly prevented by the Mas receptor antagonist A779. The expression of ACE2 and Mas receptors in the plasma membrane fraction of the lumbar dorsal spinal cord was both significantly decreased in STZ mice. Spinal ACE2 activity was also decreased while p38 MAPK phosphorylation was increased in the lumbar dorsal region of these mice. This phosphorylation was attenuated by the injection of Ang (1-7), whose effect was reversed by A779. CONCLUSIONS: Our data demonstrate that Ang (1-7) attenuates STZ-induced diabetic neuropathic pain and that this occurs through a mechanism involving spinal Mas receptors and he inhibition of p38 MAPK phosphorylation. SIGNIFICANCE: The ACE2/Ang (1-7)/Mas receptor axis was down-regulated in the spinal cord of STZ mice and the i.t. administration of Ang (1-7) attenuated the STZ-induced diabetic neuropathic pain via Mas receptors. Therefore, the activation of this axis could be an effective therapeutic target to alleviate the neuropathic pain in diabetic patients.

Clinical, electrophysiological findings and evaluation of prognosis of patients with Guillain-Barré syndrome.

Kiliç B, Güngör S, Özgör B. Clinical, electrophysiological findings and evaluation of prognosis of patients with Guillain-Barré syndrome. Turk J Pediatr 2019; 61: 200-208. Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy characterized by frequent rapid progressive, ascending, symmetric weakness and areflexia. We aimed to evaluate the etiology, clinical and electrophysiological findings with treatment and prognosis of the patients with GBS in our clinic. Patients who were diagnosed with GBS in our clinic between 2009 and 2017 were evaluated retrospectively. The study included 20 female and 25 male patients. The most frequent symptom was the absence of walking (95.5%). All of the patients had muscle weakness on examination; in addition to that hyperesthesia (31%), autonomic symptoms (13.3%), sensory loss (11.1%), ataxia (11.1%), bilateral facial nerve palsy (6.6%), oculomotor nerve palsy (2.2%), and multiple cranial nerve involvement (2.2%) were the other detected findings. Ventilation support was required in 6 cases (13.3%). Acute motor axonal neuropathy (AMAN) was found in 20 patients (44.5%), acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was found in 24 patients (53.3%), and acute motor and sensory axonal neuropathy (AMSAN) was only present in 1 patient (2.2%). Intravenous immunoglobulin (IVIG) was administered to 33 of the patients (73.3%). The mean hospital stay was 8.4±3.5 (2-17 days), and the relationship between the duration of hospital stay and the treatment given was statistically significant (p = 0.001). Complete remission was observed in 37 patients (82.3%) and the remaining 5 children (11.1%) experienced incomplete recovery. Three patients (6.7%) died of treatment-resistant hypotension, arrhythmia and severe pulmonary infection. The short duration of neurological deficit following infection, clinical stage of application, need for mechanical ventilation, dysautonomia, cranial nerve involvement, and current subtype were the negative prognostic factors. Although GBS is a self-limiting disease, early diagnosis and treatment are very important to reduce hospital stay with morbidity and mortality. Patients expected to be at high risk should be monitored closely.

Age- and localization-dependent functional and psychosocial impairments and health related quality of life six months after OSCC therapy.

OBJECTIVES: The aim of the current study was to evaluate the functional and psychosocial impacts and changes in overall quality of life (QoL) following oral squamous cell carcinoma (OSCC) therapy in different age groups and in different oral locations. MATERIALS AND METHODS: The study assessed questionnaire responses from patients with OSCC (n = 1319) after 6 months of oncologic therapy, as collected in the DÖSAK Rehab Study. Oncological variables, dental status, sensory, QoL, psychosocial outcomes and coping strategies in younger (45-60 years) and older (61-100 years) patients were assessed for different OSCC locations including the entire oral cavity, maxilla, mandible and others besides the maxilla and mandible. RESULTS: Younger patients were generally less satisfied with their dental status and experienced more sensory and QoL impairments, as well as more psychological burden, compared to the older patients. Depending on the age group, different coping strategies were used. Oncologic therapy targeted to the mandible and other locations besides the maxilla and mandible led to the strongest sensory and QoL limitations. CONCLUSIONS: Regardless of age, oncologic OSCC therapy leads to profound sensory and psychosocial restrictions and to limitations in QoL. Reasons for the poorer functional and QoL outcomes in younger patients include a more invasive treatment and a lower psychosocial resilience. The identification of patients with depressive and dysfunctional coping strategies should be carried out for all ages, but especially in younger patients, in order to develop functional coping strategies through individualized counseling, treatment and rehabilitation. REGISTRATION OF CLINICAL TRIALS: Observational study, therefore not required.

NOTALGIA PARESTHETICA.

- Notalgia paresthetica is a common, although under-recognized condition characterized by localized chronic pruritus in the upper back, most often affecting middle-aged women. Apart from pruritus, patients may present with a burning or cold sensation, tingling, surface numbness, tenderness and foreign body sensation. Additionally, patients often present with hyperpigmented skin at the site of symptoms. The etiology of this condition is still poorly understood, although a number of hypotheses have been described. It is widely accepted that notalgia paresthetica is a sensory neuropathy caused by alteration and damage to posterior rami of thoracic spinal nerves T2 through T6. To date, no well-defined treatment has been found, although many treatment modalities have been reported with varying success, usually providing only temporary relief.

Bilateral Upper Extremity Hyperesthesia and Absence of Neck Tenderness in Four Adolescent Athletes With Cervical Spine Injuries.

Cervical spine injury in the pediatric athlete is an uncommon but potentially devastating condition that can require a heightened index of suspicion to correctly diagnose. Although some cervical spine injuries present overtly with paraplegia due to cord transection, others can present more subtly with symptoms suggestive of bilateral peripheral neuropathy. Patients with traumatic brachial neuropraxia or "stinger" physiology can present similarly, but symptoms are exclusively unilateral. We present 4 patients with bilateral upper extremity hyperesthesias and absence of tenderness over the cervical vertebral landmarks who were subsequently diagnosed with cervical spine injuries.

Anesthesia Procedure for Congenital Insensitivity to Pain in a Child with Anhidrosis Syndrome: A Rare Case.

Congenital insensitivity to pain with anhidrosis (CIPA) syndrome is a neuropathy characterized by insensitivity to pain, impaired thermoregulation, anhidrosis, and mental retardation. A 9-year old boy with CIPA syndrome, underwent 2 operations for a calcaneal ulcer. During the first operation standard monitorization was performed. In the second operation, Bispectral Index (BIS) monitoring was added and temperature was monitored with an esophageal probe. In the first operation, in which anesthesia induction was applied with ketamine and midazolam, extremity movements with surgical stimuli were seen. Despite pain insensitivity, as extremity movements were seen with surgical stimuli, propofol was administered in the second operation. Throughout the operation, the BIS values varied from 19-58 and body temperature was measured as 36.1°C-36.9°C. In conclusion, despite the absence of pain sensitivity in CIPA syndrome cases, there is an absolute need for the administration of anesthesia in surgical procedures because of tactile hyperesthesia.

Eficacia de un dentífrico con dióxido de silicio obliterante en pacientes con hiperestesia dentinaria / Efficacy of a toothpaste containing precipitated silica particles in patients with dentin hyperesthesia

Introducción: la hiperestesia dentinaria se caracteriza por un dolor intenso y breve asociado a la exposición de estímulos térmicos, táctiles, osmóticos o químicos. De prevalencia creciente, reduce la calidad de vida del paciente. Objetivo: evaluar la eficacia, aceptabilidad y tolerancia de un dentífrico con dióxido de silicio obliterante, nitrato potásico y monofluorofosfato sódico en pacientes con hiperestesia dentinaria. Métodos: estudio observacional y longitudinal (n= 22) en el que se aplicó el dentífrico 3 veces/día durante 28 días. Se realizó una evaluación clínica, antes y después de la aplicación, a las 48 horas, a las 96 horas y los días 7, 14, 21 y 28 del estudio. Se evaluó su eficacia en términos de reducción de la hipersensibilidad dental determinada mediante técnica táctil (escala de calificación verbal) y de chorro de aire (escala de Schiff). En cada visita se valoró la tolerancia del producto. Los pacientes valoraron el grado de hipersensibilidad y su percepción del producto mediante un cuestionario de evaluación subjetiva. El estudio se realizó bajo los principios de Buena Práctica Clínica. Resultados: la hipersensibilidad dental se redujo en todos los puntos temporales del estudio y fue significativa (p< 0,05) a partir del día 5. Esta mejoría fue sostenida y aumentó a medida que avanzó el tratamiento. El día 29 la hipersensibilidad media se redujo en un 85 por ciento respecto al valor basal en todos los pacientes. El 91 por ciento de los participantes opinó que el dentífrico había cumplido sus expectativas. No se observó ninguna reacción adversa derivada del uso del producto. Conclusiones: el dentífrico, administrado 3 veces/día, consiguió una reducción de la hipersensibilidad dental, significativa a partir del día 5, que fue aumentando con el tiempo. El producto presentó muy buena aceptabilidad y tolerancia(AU)

Introduction: dentin hypersensitivity is characterized by sharp pain of short duration associated with exposure to thermal, tactile, osmotic or chemical stimuli. Dentin hypersensitivity is a disorder of growing prevalence which reduces the quality of life of patients. Objective: evaluate the efficacy, acceptability and tolerance of a toothpaste with precipitated silica, potassium nitrate and sodium monofluorophosphate in patients with dentin hypersensitivity. Methods: an observational longitudinal study was conducted (n= 22) in which the toothpaste was applied 3 times a day for 28 days. Clinical assessment was performed before and after the application, at 48 hours, at 96 hours and on days 7, 14, 21 and 28 of the study. Efficacy was evaluated in terms of dental hypersensitivity reduction as determined by tactile (Verbal Rating Scale) and air jet (Schiff scale) techniques. Tolerance to the product was assessed in every visit. Patients ranked the degree of hypersensitivity and their perception of the product by means of a subjective assessment questionnaire. The study complied with Good Clinical Practice principles. Results: areduction was observed in dental hypersensitivity at all time points throughout the study, and it was significant (p< 0,05) as of day 5. This improvement was sustained and increased as treatment progressed. On day 29 mean hypersensitivity had reduced 85 percent with respect to baseline value in all patients. 91 percent of the patients stated that the toothpaste had met their expectations. No adverse reaction attributable to the product was observed. Conclusions: applied 3 times/day, the toothpaste obtained a reduction in dental hypersensitivity, which was significant as of day 5. This improvement increased over time. The product had very good acceptability and tolerance(AU)

A Rare Complication of Infraorbital Nerve Hyperesthesia in Surgically Repaired Orbital Fracture Patients.

Injury to the peripheral sensory branches of the trigeminal nerve can follow a wide variety of craniofacial injuries. Many patients with facial fractures complain about the symptom of numbness to the distribution of injured nerve, which is indicative of hypoesthesia. Hyperesthesia involving the infraorbital nerve is rare in comparison to hypoesthesia secondary to facial trauma. The authors report on 2 patients with infraorbital nerve hyperesthesia in surgically repaired orbital fracture patients. Surgical decompression of the infraorbital nerve led to rapid resolution of hyperesthesia. To the best of our knowledge, these were rare cases of patients who presented with persistent hyperesthesia. Clinician should perform early surgical decompression of the infraorbital nerve in patient with persistent hyperesthesia of the infraorbital nerve.

Validation of the French version of the Burn Specific Health Scale-Brief (BSHS-B) questionnaire.

INTRODUCTION: The Burn Specific Health Scale-Brief questionnaire is a widely validated tool for estimating the health related quality of life and for assessing the best multidisciplinary management of burn patients. The aim of this study was to translate the BSHS-B into French and to investigate its reliability and validity. METHODS: According to the procedure proposed by the Scientific Advisory Committee of the Medical Outcomes Trust, the Burn Specific Health Scale-Brief (BSHS-B) was translated from the English version into French. In order to test the reliability of the French version of the BSHS-B, 53 burn patients French speakers completed the BSHS-B and SF-36 questionnaires from two to four years after burn. Ten of them have been re-tested at 6 months after the first evaluation. To evaluate clinical utility of the BSHS-F, internal consistency, construct validity (using SF-36) and stability in time were assessed using Cronbach's alpha statistic, Spearman rank test, and intra-class correlation coefficient respectively. RESULTS: The French version of the BSHS-B Cronbach's alpha coefficient was 0.93 and was >0.80 for all the sub-domains. French version of the BSHS-B and the SF-36 were positively correlated, all the associations were statistically significant (p<0.01). Intra-class correlation coefficients for test-retest ranged between 0.95 and 0.99 for the sub-domains. The intra-class correlation coefficient (ICC) for the total score was 0.98. CONCLUSION: The French version of the BSHS-B shows a robust rate of internal consistency, construct validity and stability in time, supporting its application in routine clinical practice as well as in international studies.

Addition of posttraumatic stress and sensory hypersensitivity more accurately estimates disability and pain than fear avoidance measures alone after whiplash injury.

The fear avoidance model (FAM) has been proposed to explain the development of chronic disability in a variety of conditions including whiplash-associated disorders (WADs). The FAM does not account for symptoms of posttraumatic stress and sensory hypersensitivity, which are associated with poor recovery from whiplash injury. The aim of this study was to explore a model for the maintenance of pain and related disability in people with WAD including symptoms of PTSD, sensory hypersensitivity, and FAM components. The relationship between individual components in the model and disability and how these relationships changed over the first 12 weeks after injury were investigated. We performed a longitudinal study of 103 (74 female) patients with WAD. Measures of pain intensity, cold and mechanical pain thresholds, symptoms of posttraumatic stress, pain catastrophising, kinesiophobia, and fear of cervical spine movement were collected within 6 weeks of injury and at 12 weeks after injury. Mixed-model analysis using Neck Disability Index (NDI) scores and average 24-hour pain intensity as the dependent variables revealed that overall model fit was greatest when measures of fear of movement, posttraumatic stress, and sensory hypersensitivity were included. The interactive effects of time with catastrophising and time with fear of activity of the cervical spine were also included in the best model for disability. These results provide preliminary support for the addition of neurobiological and stress system components to the FAM to explain poor outcome in patients with WAD.