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Spectrum of cutaneous hyperalgesias/allodynias in neuropathic pain patients
Author(s) -
Verdugo R. J.,
Bell L. A.,
Campero M.,
Salvat F.,
Tripplett B.,
Sonnad J.,
Ochoa J. L.
Publication year - 2004
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/j.1600-0404.2004.00341.x
Subject(s) - hypoesthesia , neuropathic pain , medicine , hyperalgesia , allodynia , nociception , anesthesia , psychogenic disease , neuroscience , complex regional pain syndrome , psychology , psychiatry , receptor
Objectives – The aim of this study was to discern the pathophysio‐logical bases for neuropathic hyperalgesias. Methods – In this study, neurological and neurophysiological evaluation of 132 consecutive hyperalgesia patients using rigorous clinical and laboratory protocols were carried out. Results – Two discrete semeiologic entities emerged: classic neurological vs atypical, fulfilling taxonomically complex regional pain syndrome (CRPS) II and I, respectively. The classic group (34.9%) exhibited sensorimotor patterns restricted to nerve distribution and documented nerve fiber dysfunction. Among them four (3.03%) had sensitization of C‐nociceptors, seven (5.3%) had central release of nociceptive input, and 35 (26.52%) probable ectopic nerve impulse generation. The atypical group (65.1%) displayed weakness with interrupted effort; non‐anatomical hypoesthesia and hyperalgesia; hypoesthesia or paresis reversed by placebo, or atypical abnormal movements, and physiological normality of motor and sensory pathways. Conclusions – Spatiotemporal features of neuropathic hyperalgesia constitute key criteria for differential diagnosis between CRPS II and I and, together with other behavioral sensorimotor features, signal psychogenic pseudoneurological dysfunction vs structural neuropathology. ‘Neuropathic’ hyperalgesias may reflect neuropathological or psychopathological disorders.