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Changes in Temperature Sensation Measured With Quantitative Sensory Testing in Patients With Post-Traumatic Cold Intolerance
E.S. Smits; E.T. Walbeehm, MD, PhD; E.A.M. Van Bodegraven-Hof; Frank J.P. Huygen, MD, PhD; S.E.R. Hovius, MD, PhD; Ruud W. Selles, PhD
Erasmus MC - University Medical Center, Rotterdam, Netherlands
Cold intolerance remains an unresolved condition with variable symptoms. Quantitative Sensory testing is a valid and quantitative technique that allows for direct interpretation of the behavior of the different types of small ending nerve fibers and may elucidate changes in these nerve endings in cold intolerance.
Methods: Fifteen controls and eight patients after a peripheral nerve injury and diagnosed with cold intolerance using the Cold intolerance Symptom Severity (CISS) questionnaire where included. All patients were subjected to quantitative thermal sensory testing using a Medoc TSA-II Neurosensory analyzer. Subjects were measured on the part of the dermatome with the most complaints. We measured both the threshold for detecting a change in temperature as well as for the cold and warmth pain threshold.
Results: The cold detection threshold in patients was significantly (p=0.01) increased (mean change -4.3șC, SD±1.3) compared to controls (-1.2șC±0.5). Similarly, warmth detection threshold in patients was significantly (p<0.01) increased (3.3șC±2.1) compared to controls (1.1șC±0.3). Cold pain threshold was significantly (p=0.02) higher in the patients (21.4șC±3.1) versus the controls (11.4șC±6.9); in contrast, warmth pain threshold was not significantly different (p=0.37) in patients (42.2șC±2.2) versus controls (42.4șC±2.9).
Conclusion: We found that patients had a larger threshold for detecting temperature changes compared to controls, both for warmth and cold. When cooling, patients reported pain at higher temperatures than controls. Based on literature, these changes indicate that the peripheral sensory channels of A-delta and C fibers are disordered in these patients compared to controls.
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