Premium
Painful and non‐painful neuropathy in HIV‐infected patients: an analysis of somatosensory nerve function
Author(s) -
Martin Claes,
Solders Göran,
Sönnerborg Anders,
Hansson Per
Publication year - 2003
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/s1090-3801(02)00053-8
Subject(s) - medicine , quantitative sensory testing , peripheral neuropathy , neuropathic pain , somatosensory system , anesthesia , sensory system , sensory threshold , neurological examination , nerve conduction , sensation , physical examination , surgery , diabetes mellitus , psychology , psychiatry , cognitive psychology , endocrinology , cognitive science , neuroscience
Fifteen to 50% of AIDS‐patients suffer from distal predominantly sensory neuropathy (DSP), which is commonly associated with painful symptoms. In the present study, we have focused on the function of fine calibre nerve channels, in 36 consecutive HIV‐1‐infected patients with painful (PPN) ( n =20; 54%) and non‐painful (PN) ( n =16) sensory neuropathy, assessed by clinical, quantitative thermal testing (QTT) (31/36), and peripheral nerve conduction examination (32/36). Control QTT data were obtained from 49 healthy subjects with a corresponding age‐ and sex distribution. Demographics, antiviral treatment, immunological status, and nerve conduction examination did not differ between patients with and without painful symptoms. Hypoaesthesia to warmth, cold, and heat pain was observed in both neuropathy groups when compared to healthy controls. However, the perception threshold to warmth was more often impaired ( p <0.01) and the level of impairment was more pronounced ( p <0.001) in patients with painful neuropathy. Furthermore, increased pain sensitivity to cold was found only in patients with painful symptoms ( p <0.05). An abnormal outcome of any QTT parameter was found in all patients with pain, but only among 62% of patients without pain, p <0.01, and the cumulative frequency of abnormalities in any of the four thermal percepts (warmth, cold, heat pain, and cold pain) was higher in patients with painful symptoms, p <0.0001. This study demonstrates a more pronounced impairment of C‐fibre‐mediated innocuous warm perception in patients with painful neuropathy, which in the setting of impaired or absent heat pain perception suggests a more generalised loss of function in somatosensory C‐fibre channels.