Oral Neuropathy Associated with Commonly used Chemotherapeutic Agents: A Narrative Review.

PURPOSE OF REVIEW: Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent complication of cytotoxic chemotherapeutic agents; its incidence largely varies, depending on type, dose, agent and preexisting risk factors. Oral-and-perioral-CIPN (OCIPN) is underreported. Neurotoxic agents can cause jaw pain or numbness. This review aims to present available data on OCIPN RECENT FINDINGS: A narrative literature review, following SANRA guidelines was conducted. PubMed and Cochrane databases were searched until September 2023. Articles referring to neuropathy or neuropathic pain due to head and neck cancer, head and neck radiotherapy, oropharyngeal mucositis, infection or post-surgical pain were excluded. Platinum-based chemotherapeutics, taxanes, vinca alkaloids, immunomodulatory and alkylating agents can cause OCIPN. Platinum-based chemotherapeutics can cause orofacial cold sensitivity, orofacial and jaw pain, oral cavity tingling and teeth hypersensitivity. Taxanes may induce oral cavity and tongue numbness and tingling as well as hot hypersensitivity. Vinca alkaloids may cause jaw, teeth and lips pain and oral mucosa hyperalgesia. Immunomodulatory drugs can cause lips, tongue and perioral numbness, while alkylating agents induce tongue and lips tingling and teeth cold-hypersensitivity. Chemotherapy may cause OCIPN due to changes in cellular structure and function, like alterations in membrane receptors and neurotransmission. OCIPN should be documented and physicians, dentists and health care providers should be alerted.

Normal or tingly? A story about hands and feet.

AIMS: Spontaneous sensations (SPS) are sensations that are felt in the body in the absence of external stimulation. The literature on SPS has used explicit measures, such as questionnaires to explore SPS, while no studies to date have examined SPS on an implicit level. This study was conducted to collect representative stimuli that can be used to build such a task, for example, an Implicit Association Test. METHODS: An online survey was completed by 18 participants to identify the most frequent words used to describe our limbs in the presence or absence of SPS. RESULTS: Individuals who perceive and those who do not perceive SPS in their limbs describe their limbs as normal, while the most frequently described SPS were itching and tingling. CONCLUSIONS: Thus, we use the same words/adjectives to describe how we perceive our limbs. However, the way we experience SPS varies as we experience more SPS in hands than feet.

Painful and non-painful chemotherapy-induced peripheral neuropathy and quality of life in colorectal cancer survivors: results from the population-based PROFILES registry.

PURPOSE: This study aims to (1) examine the prevalence of painful versus non-painful chemotherapy-induced peripheral neuropathy (CIPN) among long-term colorectal cancer (CRC) survivors, (2) identify sociodemographic, clinical, and psychological factors associated with painful and non-painful CIPN, and (3) examine the associations of painful CIPN with health-related quality of life (HRQoL) in comparison with non-painful CIPN, i.e., numbness/tingling. METHODS: All CRC survivors diagnosed between 2000 and 2009 as registered by the population-based Netherlands Cancer Registry (Eindhoven region) were eligible for participation. Chemotherapy-treated survivors (n = 477) completed questions on CIPN (EORTC QLQ-CIPN20) and HRQoL (EORTC QLQ-C30). RESULTS: Painful CIPN was reported by 9% (n = 45) of survivors and non-painful CIPN was reported by 22% (n = 103). Time since diagnosis was related to painful CIPN, and time since diagnosis, a higher disease stage, osteoarthritis, and more anxiety symptoms were related to non-painful CIPN. Finally, survivors with painful CIPN reported a worse global quality of life and worse physical, role, cognitive, and social functioning compared to survivors with non-painful CIPN and those without any sensory CIPN. No differences were found between survivors with non-painful CIPN and those without sensory CIPN. CONCLUSIONS: It seems that painful CIPN must be distinguished from non-painful CIPN, as only painful CIPN was related to a worse HRQoL. Future research is needed to examine whether painful CIPN must be distinguished from non-painful CIPN regarding predictors, mechanisms, and treatment.

Response of localized, resistant, tingling vitiligo to pregabalin: A case report.

Vitiligo is a common depigmenting disease with complex pathogenesis. One of the proposed pathogenesis is the neural hypothesis, which suggests an altered reaction to neuropeptides, catecholamines, and their metabolites affecting melanocytes. Here, we report a case of 26-year-old female patient, whose vitiligo patches were associated with unusual crawling and tingling sensation and responded to a clinical trial of pregabalin.

Characterization of perception by transcutaneous electrical Stimulation in terms of tingling intensity and temporal dynamics.

Electrotactile feedback is a cost-effective and versatile method to provide new information or to augment intrinsic tactile feedback. As tactile feedback provides critical information for human-environment interaction, electrotactile feedback, accordingly, has many purposes to improve the quality of human-environment interaction in both direct and remote settings. However, electrotactile feedback overlays tingling sensation on top of the natural tactile feedback. To better characterize electrotactile feedback and understand the origin of the tingling sensation, a need arises to characterize the human perception of electrotactile feedback qualitatively and quantitatively, while varying the key stimulation parameters, namely amplitude and frequency. This study consists of two experiments. In the first experiment, the voltage for each subject was characterized by setting perception and discomfort thresholds. In the second experiment, subjects received electrical stimulation in 9 different combinations of voltages and frequencies. On delivering stimulation with each parameter combination, subjects reported their perception in two comparative scales-pressure vs. tingling and constant vs. pulsing. Subjects also reported the location of perception for stimulation with every parameter combination. More tingling and less pressure was reported as frequency increased, while the tingling-pressure percept was not affected by the amplitude change. Additionally, less pulsing and more constant was reported as frequency increased, while the pulsing-constant percept was not affected by the amplitude change. Concurrently, the normalized level of voltage thresholds was decreased as frequency increased. Dependency of tingling-pressure percept on stimulation frequency suggests that incongruency between the stimulation frequency and the natural firing rate of the sensory neuron would be an important factor of the tingling sensation. This study is a steppingstone to further demystify the origin of the tingling percept caused by electrical stimulation, thus broadening the use of transcutaneous electrical stimulation as a way of providing tactile cue or augmentation.

Predicting tingling sensations induced by autonomous sensory meridian response (ASMR) videos based on sound texture statistics: a comparison to pleasant feelings.

Sound serves as a potent medium for emotional well-being, with phenomena like the autonomous sensory meridian response (ASMR) showing a unique capacity for inducing relaxation and alleviating stress. This study aimed to understand how tingling sensations (and, for comparison, pleasant feelings) that such videos induce relate to acoustic features, using a broader range of ASMR videos as stimuli. The sound texture statistics and their timing predictive of tingling and pleasantness were identified through L1-regularized linear regression. Tingling was well-predicted (r = 0.52), predominantly by the envelope of frequencies near 5 kHz in the 1500 to 750 ms period before the response: stronger tingling was associated with a lower amplitude around the 5 kHz frequency range. This finding was further validated using an independent set of ASMR sounds. The prediction of pleasantness was more challenging (r = 0.26), requiring a longer effective time window, threefold that for tingling. These results enhance our understanding of how specific acoustic elements can induce tingling sensations, and how these elements differ from those that induce pleasant feelings. Our findings have potential applications in optimizing ASMR stimuli to improve quality of life and alleviate stress and anxiety, thus expanding the scope of ASMR stimulus production beyond traditional methods. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

The contribution of subliminal perceptions, dietary habits, and psychological traits to the perception of oral tingling and burning sensations.

The tingling evoked by Sichuan pepper and the burning elicited by chili pepper constitutes the typical flavor of Sichuan cuisine and is a component of leisure food. Although factors affecting the burning sensation have extensively been studied, few studies have examined the factors of individual sensitivity, personality traits, and dietary habits that contribute to the perception of oral tingling sensation, which hinders the formulation of tingling products and the development of new products. In contrast, many studies have examined the factors influencing the burning sensation. In this web-based survey, 68 participants disclosed their dietary habits, liking for tingling and hot foods, and psychological traits. Individual sensitivity to the tingling and burning sensation produced by a range of Sichuan pepper oleoresin and capsaicin solutions was determined using rated differences from control, generalized labeled magnitude scale method and ranking test. The consistency score indicated the accuracy of individual ranking results while also providing an indirect response to the sensitivity of the participant to supra-threshold for burning or tingling. Individual ratings for medium Sichuan pepper oleoresin concentrations significantly correlated with the just noticeable difference (p < 0.01), and ratings for medium and high capsaicin concentrations correlated significantly with 6-n-propylthiouracil ratings (p < 0.01). Notably, the power exponent of burning was significantly correlated with the burning recognition threshold (p < 0.01), and the power exponent of tingling and burning were significantly correlated (r = 0.340, p < 0.05). There was a negative correlation between supra-threshold tingling and burning sensation perceptions and life satisfaction ratings. Further, intensity ratings for oral tingling and burning sensation did not always correspond with individual sensitivity indicators (e.g., recognition threshold, 6-n-propylthiouracil, just noticeable difference, and consistency score). Thus, this study provides new insight into establishing a sensory selection method for chemesthetic sensation panelists and theoretical guidelines for formulation design and in-depth analysis of popular tingling dishes and foods.

A Pragmatic Neuro-Rehabilitation Approach for Basilar Invagination: A Case Report.

Basilar invagination is a rare pathology of the occipital bone, along with prolapsing of the vertebral column. It is a narrowing in the opening of the foramen magnum of the odontoid process. It is a well-known cause of pain and tingling in the upper limbs. However, only a few afflictions requiring physiotherapy rehabilitation in basilar invaginations have been reported. Thus, this study was carried out to investigate a case of basilar invagination. A 51-year-old female visited the neuro-outpatient department. The chief complaints of the patient were restricted overhead activities, restricted neck and shoulder movements, upper limb weakness, and tingling of bilateral upper limbs for the past two months. Clinical examination revealed pain thresholds for the neck and shoulder at nine by ten on activity and five by ten on rest. Manual muscle testing revealed a significant reduction in the strength of muscles around the neck and shoulder at three by five on bilateral upper limbs. The patient was advised to have computed tomography (CT), magnetic resonance imaging (MRI), and a bone density test to confirm the diagnosis of the condition. Investigations revealed a case of basilar invagination. But due to the financial burden, surgery couldn't be opted for; therefore, she opted for physiotherapy rehabilitation. The patient was managed with neuro-physiotherapy rehabilitation exercises like neural tissue stretch, which included nerve gliding and nerve stretching exercises, vestibular rehabilitation exercises, and gaze stabilization exercises. The strengthening of weakened muscles was done using Delorme's technique. Cervical traction, electrotherapy, and moist heat modalities like interferential therapy and hydrocollator packs were given. It also included deep breathing exercises like diaphragmatic breathing and thoracic expansion exercises. The exercise was planned according to the frequency, intensity, time, and type (FITT) principle. Frequency: five days/week; intensity: slow to moderate pace with rest intervals; time: 60 minutes/day; type of exercise: strength training along with other exercises for a total of thirty days. The patient was able to resume her job after receiving physiotherapy rehabilitation, which played a pivotal role in decreasing her symptoms.

Characteristics of current perception produced by intermediate-frequency contact currents in healthy adults.

Introduction: Contact electrical currents in humans stimulate peripheral nerves at frequencies of <100 kHz, producing sensations such as tingling. At frequencies above 100 kHz, heating becomes dominant, resulting in a sensation of warmth. When the current amplitude exceeds the threshold, the sensation results in discomfort or pain. In international guidelines and standards for human protection from electromagnetic fields, the limit for the contact current amplitude has been prescribed. Although the types of sensations produced by contact current at low frequencies, i.e., approximately 50-60 Hz, and the corresponding perception thresholds have been investigated, there is a lack of knowledge about those in the intermediate-frequency band-particularly from 100 kHz to 10 MHz. Methods: In this study, we investigated the current-perception threshold and types of sensations for 88 healthy adults (range: 20-79 years old) with a fingertip exposed to contact currents at 100 kHz, 300 kHz, 1 MHz, 3 MHz, and 10 MHz. Results: The current perception thresholds at frequencies ranging from 300 kHz to 10 MHz were 20-30% higher than those at 100 kHz (p < 0.001). In addition, a statistical analysis revealed that the perception thresholds were correlated with the age or finger circumference: older participants and those with larger finger circumferences exhibited higher thresholds. At frequencies of ≥300 kHz, the contact current mainly produced a warmth sensation, which differed from the tingling/pricking sensation produced by the current at 100 kHz. Discussion: These results indicate that there exists a transition of the produced sensations and their perception threshold between 100 kHz and 300 kHz. The findings of this study are useful for revising the international guidelines and standards for contact currents at intermediate frequencies. Clinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000045660, identifier UMIN 000045213.

Neurological Features and Their Association With Gender in Diabetes Mellitus Patients.

Introduction Understanding the wide range of clinical signs and symptoms associated with diabetes mellitus (DM) is crucial because people with DM are frequently misdiagnosed, given incorrect care, or poorly controlled. Therefore, the purpose of this study was to evaluate the neurological symptoms associated with type 1 and type 2 DM patients with respect to patient gender. Methods This was a cross-sectional multicenter study that was conducted at different hospitals using a non-probability sampling method. The duration of the study was eight months, from January 2022 to August 2022. The study involved 525 type 1 and type 2 DM patients with an age range from 35 to 70 years. Demographic details such as age, gender, socioeconomic status, past medical history, presence of comorbidities, type, and duration of DM, and neurological features were recorded as frequencies and percentages. A Chi-square test was used to determine the association between neurological symptoms associated with type 1 and type 2 DM and gender. Results The study findings showed that of 525 diabetic patients, 210 (40.0%) were females and 315 (60.0%) were males. The mean male and female mean ages were 57.36±14.99 and 50.52±14.8 years, respectively, with a significant difference with respect to gender (p<0.001). The prevalence of neurological manifestations showed that irritability or mood swings were reported by most of the male 216 (68.6%) and 163 (77.6%) female diabetic patients, with a significant association noticed (p=0.022). Moreover, a significant association was observed between both genders in terms of swelling of feet, ankles, hands, and eyes (p=0.042), confusion or difficulty in concentration (p=0.040), burning pain in feet or legs (p=0.012), and muscular pain or cramps in legs or feet (p=0.016).  Conclusion This study concluded that the prevalence of neurological manifestations was high among diabetic patients. Most of the neurological symptoms were significantly more pronounced in female diabetic patients. Moreover, most of the neurological symptoms were associated with the type (type 2 DM) and duration of DM. The presence of hypertension, dyslipidemia, and smoking also influenced some neurological manifestations.

Pain, paresthesia, and the rotator cuff: the prevalence and magnitude of shoulder pain and hand numbness and tingling before and after rotator cuff repair.

Background: Shoulder pain and loss of function are classically associated with rotator cuff tears, while paresthesia of the hand is not. We noted anecdotally that paresthesia of the arm was common in patients presenting with rotator cuff tears. The purpose of this study was to determine the prevalence and magnitude of hand paresthesia, its relationship to pain, and how surgery affected these symptoms. Methods: This prospective cross-sectional study assessed the prevalence and magnitude of shoulder pain and hand numbness and tingling (as assessed by 2 questions from the modified Boston Carpal Tunnel Questionnaire) preoperatively and at 1 week, 6 weeks, 12 weeks, and 6 months postoperatively among 213 consecutive patients who presented for and underwent arthroscopic rotator cuff repair. Results: The preoperative levels of prevalence and severity of shoulder pain during rest, overhead activities, and sleep improved by 52%, 22%, and 34%, respectively, compared with those by 6 months postoperatively (P < .05). Seventy-five patients (33%) reported hand paresthesia before surgery. There was a 50% and 60% reduction in the severity of hand tingling and numbness, respectively, by 1 week after surgery (P < .05). The preoperative level of hand numbness (Wald statistic; W = 20) and whether the patient's shoulder problem was caused by a specific injury (W = 6) were predictive of the presence of hand numbness at 6 months after surgery (P < .05). Conclusion: This study showed that many patients who undergo rotator cuff repairs present with hand paresthesia that is associated with their shoulder pain. The prevalence and severity of shoulder pain and hand numbness and tingling improved postoperatively.

Patterns and Correlates of Physical Symptoms among People with Peripheral Neuropathy.

Background: As the population ages and more people are affected by multiple chronic conditions, the prevalence of Peripheral Neuropathy (PN) has also rapidly increased. This swift rise in PN leaves clinicians and patients challenged by a lack of consistent diagnosis and treatment guidelines. Purpose: To assist those affected by PN, it is imperative to understand the breadth of symptoms, experiences, and factors related to the quality of life. The primary aims of this study are to (1) characterize the symptoms of PN in a nationwide sample; (2) discern differences in symptom clusters, given perceived causes of PN; and (3) identify significant physiological symptoms related to the quality of life for people with PN. Methods: An online survey of people in online PN support groups. Participants were recruited primarily via an open request sent to recipients of web-based communications from nationally recognized online PN support groups. Inclusion criteria were as follows: Self-reported diagnosis of PN, ability to read English or Spanish, residence in the U.S., and age ≥ 18 years. Results: A total of 608 individuals with PN were included in the analysis. This sample represents 49 U.S. states and the District of Colombia; 221 were male and 387 female. Their disease severity and etiology were similar to previously reported information on this population, with 53.3% of respondents suffering from PN without a known cause. Among known causes, diabetes was the most common (19.6%), followed by chemotherapy (6.9%) and autoimmune diseases (3.6%). Factors affecting the quality of life among people with PN included lower extremity mobility, upper extremity mobility, sleep disturbance, depressive symptoms, and patient activation.

Interest in Micellar Solution to Reduce Unpleasant Skin Sensations.

INTRODUCTION: The results from the "Objectifs Peau" project showed that approximately 30% of the French population complains of an unpleasant skin sensation at least once a day. Itching was the most frequent complaint (32%), followed by tingling (18.9%) and burning sensation (5.6%), which impact an individual's daily life. These sensations could be identified, as they were either isolated or associated with each other. The aim of this study was to evaluate the use of micellar solution to reduce these sensations, especially on sensitive skin. METHODOLOGY: A questionnaire was administered at Day 0 (D0), D2, D14, and D28 using a mobile phone application to individuals applying micellar solution (Sensibio H2O, Laboratoire Bioderma, NAOS) who spontaneously used micellar solution for sensitive skin and/or spontaneously consulted a health professional. Itching, tightness, tingling and burning sensations were evaluated by means of frequencies (never, rarely, sometimes, often or constantly) at D0, D2, D14 and D28. Responses from the questionnaire were rated (never=0, rarely=1, sometimes=2, often=3 or constantly=4) and allowed us to obtain an overall "unpleasant sensations" score, where a higher score corresponded to a higher degree of unpleasant sensations. RESULTS: In total, 400 evaluable individuals participated in the study (97% female, average age 38.5±13 years, 82% reported sensitive skin). The "unpleasant sensations" score improved from D2 and continued significantly on D14 and D28. The improvement rates were 47.7%, 57.9% and 62.7% at D2, D14 and D28, respectively, compared to D0. The percentages of improvement at D2, D14 and D28 were 83.2% (95% CI: 79.26; 87.21), 87.54% (95% CI: 84.01; 91.06) and 90% (95% CI: 87.06; 92.94), respectively, compared to D0. CONCLUSION: The improvement in the reduction of unpleasant sensations was observed as early as 2 days after using micellar solution and increased over time. The use of this type of micellar solution, especially on sensitive skin, and the guidance of health professionals (dermatologists and pharmacists) may help to reduce the impact of unpleasant skin sensations.

Intravascular lymphoma with hypopituitarism: A case report.

BACKGROUND: Intravascular lymphoma (IVL) is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy. Because of various modes of presentation and its rarity, IVL is often diagnosed postmortem. Herein, we report a case of intravascular B-cell lymphoma with hypopituitarism, an extremely rare complication, that was successfully treated with chemotherapy. CASE SUMMARY: An 80-year-old Japanese woman presented with a 7-mo history of a tingling sensation in the lower limbs. She also presented with various other symptoms such as pancytopenia, high fever daily, and unconsciousness with hypoglycemia. Although the doctor who previously treated her diagnosed hypoglycemia as being due to hypopituitarism, the cause of the other symptoms remained uncertain despite a 7-mo evaluation period. We performed bone marrow aspiration to evaluate pancytopenia and found that she had hemophagocytic lymphohistiocytosis (HLH). On the basis of a random skin biopsy for assessing the cause of HLH, she was diagnosed with intravascular B-cell lymphoma. HLH and hypopituitarism were considered secondary to IVL. All her clinical findings matched the presentations of IVL. She was immediately treated with chemotherapy and achieved complete response. She was relapse free two years after treatment. CONCLUSION: IVL should be included in the differential diagnosis of hypopituitarism, which although life-threatening, is treatable through prompt diagnosis and appropriate chemotherapy.

Right Ventricular Perforation Presenting as Tingling of the Left Breast.

Pacemaker lead-associated cardiac perforation is a rare phenomenon. Lead perforations can be acute, subacute, or chronic following lead placement. Symptoms are typically nonspecific and depend on the location of the displaced lead. Diagnostic workup requires interrogation of the pacemaker and imaging studies. Management of lead displacement is dependent on multiple risk factors such as age, gender, corticosteroid use, and anticoagulation therapy. A 74-year-old female with a history of myosin light chain kinase (MYLK) 2 hypertrophic cardiomyopathy, Sjogren's syndrome, Raynaud's disease, and sick sinus syndrome was evaluated for an abnormal finding on pacemaker interrogation. The patient's only symptom was tingling of her left breast. Imaging studies confirmed pacemaker lead perforation. Right ventricle perforation due to a pacemaker lead displacement can cause severe complications. Early identification and treatment by physicians can reduce the risk of mortality.

Molecular basis of neurophysiological and antioxidant roles of Szechuan pepper.

The balance between anti- and pro-oxidant activities is of great important to maintain the biochemical and physiological homeostasis in the human body. Developing new therapeutic strategies to reduce health risks caused by free radicals has always been research focus over the past decades. Szechuan pepper, a characteristic pungent-flavored spice in Sichuanese cuisine, recently attracts the attention of researchers for its widespread therapeutic effects on acute and chronic diseases. The plant produces the innocuous 'tingling and numbing' sensations across the oral cavity by stirring specific neuron types, which are mechanically distinct from those excited by capsaicin. Furthermore, the extracts or the compounds of Szechuan pepper are biochemically proven to possess strong antioxidant activities that could scavenge free radicals and inhibit overactive peroxidase system in pathological models. Herein, the review emphasizes the molecular basis underlying the neurophysiological and antioxidant activities of the plant by a comprehensive analysis of various signaling pathways in disease models treated by Szechuan pepper. Further, we performed a broadening analysis to unearth potential signaling pathways associated with the antioxidant roles of the plant.

The Hoffmann-Tinel Sign: Historical Background and Clinical Significance / Sinal de Hoffmann-Tinel: Contexto histórico e significado clínico

The Hoffmann-Tinel sign is well-known to professionals dealing with nerve lesions and is widely used as a provocative test. It was described by Paul Hoffman and Jules Tinel in the same year (1915), independently. In the present article, a biographical sketch of both authors is presented and the method for eliciting the sign and the sometimes controversial information of its results are discussed.

O sinal de Hoffmann-Tinel é bem conhecido pelos profissionais que lidam com lesões de nervos, sendo amplamente utilizado como um teste provocativo. Foi descrito por Paul Hoffmann e por Jules Tinel no mesmo ano (1915), de forma independente. No presente artigo, é apresentado um esboço biográfico de ambos autores e são discutidas a forma de obter o sinal e as informações, por vezes controversas, fornecidas por seus resultados.

Complaints of Upper Extremity Numbness and Tingling Relieved With Dry Needling of the Teres Minor and Infraspinatus: A Case Report.

Study Design Case report. Background Abnormal sensation, such as numbness or tingling, is traditionally thought to originate from neural compression. There is limited evidence to support reports of abnormal sensation arising from a trigger point. Case Description The patient was a 60-year-old woman with a primary complaint of right shoulder pain and secondary complaints of neck pain and right upper extremity numbness. Cervical spine neurological examination was unremarkable, and manual examination did not reproduce the patient's arm numbness or tingling symptoms. Compression of a trigger point in the infraspinatus and teres minor reproduced the patient's primary complaint of shoulder pain. The initial intervention included dry needling, which reproduced her upper extremity numbness. Subsequent treatment included manual therapy and exercise. Outcomes The patient was seen for a total of 3 visits, including the evaluation. Dry needling was utilized in 2 of her 3 visits. At discharge, she reported complete resolution of pain and altered sensation. Additionally, her scores on the Neck Disability Index, numeric pain-rating scale, and global rating of change exceeded the minimal clinically important difference. These outcomes were maintained at 2- and 12-month follow-up phone calls. Discussion This case report described the examination and use of dry needling in a case where the diagnosis was unclear. Clinicians may consider trigger point referral when examining patients with reports of abnormal sensation, especially when a more common cause cannot be identified. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(4):287-292. Epub 3 Mar 2017. doi:10.2519/jospt.2017.7055.

The Course of Neuropathic Symptoms in Relation to Adjuvant Chemotherapy Among Elderly Patients With Stage III Colon Cancer: A Longitudinal Study.

INTRODUCTION: Among the elderly, the impairment of functional capacities due to neuropathy can have a significant impact. The aim of the present study was to investigate the course of neuropathic symptoms among elderly patients with stage III colon cancer treated with CAPOX (capecitabine, oxaliplatin), capecitabine monotherapy, or no adjuvant chemotherapy. MATERIALS AND METHODS: The Netherlands Cancer Registry was used to select patients with stage III colon cancer and aged ≥ 70 years. Questionnaires were sent after resection (T1) and 6 (T2) and 12 months (T3) later. Neuropathy was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20. Logistic generalized estimating equations analyses were used to evaluate the effect of chemotherapy on the course of neuropathic symptoms. RESULTS: Of 155 eligible patients, 117 (76%) completed the T1 questionnaire, and 69 and 59 completed the T2 and T3 questionnaires, respectively. The course of the sensory symptoms tingling fingers or hands, tingling toes or feet, numbness in fingers or hands, and numbness in toes or feet was significantly unfavorable for patients treated with adjuvant chemotherapy (CAPOX or capecitabine) compared with that for patients who had not received adjuvant chemotherapy. The course of numbness in toes or feet also differed significantly between patients treated with CAPOX (T1, 7%; T2, 50%; T3, 42%) and patients treated with capecitabine (T1, 17%; T2, 31%; T3, 8%). Additionally, patients treated with capecitabine reported significantly less tingling toes or feet (T1, 6%; T2, 25%; T3, 7%) compared with patients treated with CAPOX (T1, 0%; T2, 50%; T3, 58%). CONCLUSION: The course of several sensory symptoms over time was less favorable for elderly patients with colon cancer treated with chemotherapy. Moreover, CAPOX was associated with more symptoms in toes and feet compared with capecitabine. It is important to inform patients of these risks to enable informed decision-making.

Physiological and psychological correlates of attention-related body sensations (tingling and warmth).

Body sensations play an essential role in the subjective evaluation of our physical health, illness, and healing. They are impacted by peripheral somatic and external processes, but they are also heavily modulated by mental processes, e.g., attention, motor control, and emotion. Body sensations, such as tingling, numbness, pulse, and warmth, can emerge due to simply focusing attention on a body part. It is however an open question, if these sensations are connected with actual peripheral changes or happen "only in the mind." Here, we first tested whether the intensity of such attention-related body sensations is related to autonomic and somatomotor physiological processes and to psychological traits. In this study, attention-related body sensations were not significantly connected to changes in physiology, except warmth sensation, which was linked to decrease in muscle tension. Overall intensity of tingling significantly correlated with body awareness and tendentiously with body-mind practice. This strengthened the hypothesis that attention-related body sensations are more the result of top-down functions, and the connection with peripheral processes is weak. Here, we suggested a novel protocol to examine the effect of manipulating attention on body sensations, which together with our results and discussion can inspire future researches.