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Dynamic of the somatosensory system in postherpetic neuralgia

Gierthmühlen, Janne*; Braig, Olga; Rehm, Stefanie; Hellriegel, Jana; Binder, Andreas; Baron, Ralf

doi: 10.1097/PR9.0000000000000668
Neuropathic: PDF Only

Introduction: In postherpetic neuralgia (PHN) different types of patients can be distinguished regarding their predominant peripheral nociceptor function.

Objective: The aim was to examine somatosensory profiles in the course of disease with special regard to the different subtypes existing in PHN.

Methods: Twenty patients with PHN (7 men and 13 women, age 67 ± 9.6 years) were examined at baseline (disease duration 18.1 ± 26 months) and follow-up (31.6 ± 23.8 months later) with quantitative sensory testing (protocol of the German Research Network on Neuropathic Pain).

Results: Fourteen (70%) PHN patients presented with impaired (iPHN) and 6 (30%) with preserved (pPHN) C-fiber function. Groups did not differ regarding age, disease duration, or pain intensity at baseline. Both groups did not differ regarding change in pain intensity (−0.5 ± 2.3 vs −1.7 ± 2.6 numerical rating scale, P = n.s.) at follow-up. Impaired PHN improved in thermal and mechanical detection thresholds as well as allodynia independent from change in pain intensity. By contrast, pPHN showed an increase in mechanical pain sensitivity (1.4 ± 2.5 vs −0.4 ± 2.2, P < 0.05) and a trend towards a stronger loss of detection (66% vs 33%, P = n.s.) on follow-up.

Conclusion: Results demonstrate that patients with preserved C-fiber function are more predisposed to develop signs of central sensitization as demonstrated by an increased mechanical pain sensitivity. Impaired C-fiber function is able to improve even in chronic cases, but a functional loss is unlikely to play a role here. The knowledge of development of somatosensory profiles in the course of the disease offers possibilities to optimize a mechanism-based treatment.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany

Corresponding author. Address: Division of Neurological Pain Research and Therapy, Department of Neurology, Arnold-Heller-Str. 3, Haus 41, Kiel 24105, Germany. Tel.: +49 431 500 23911; fax: +49 431 500 23914. E-mail address: j.gierthmuehlen@neurologie.uni-kiel.de (J. Gierthmühlen).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received February 05, 2018

Received in revised form May 28, 2018

Accepted June 08, 2018

© 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.