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Homotopic stimulation can reduce the area of allodynia in patients with neuropathic pain

Love-Jones, Sarah J.
Steeds, Charlotte E.
Brook, Peter
Chizh, Boris A.
Pickering, Anthony E.
Published in European Journal of Pain. 2009, vol. 13, no. 9, p. 942-948
Abstract Allodynia is a common, troublesome feature of neuropathic pain conditions. In a previous study of postherpetic neuralgia we observed that repeated tactile stimulation appeared to reduce the size of the area of allodynia in some patients. We have undertaken a pragmatic clinical study to characterise this phenomenon in neuropathic pain patients with a range of different aetiologies. Neuropathic pain patients with a discrete area of tactile allodynia were recruited (n=20). We assessed the sensitive area using punctate and dynamic tactile stimuli, and thermal quantitative sensory testing. On two separate testing visits, the patients had repeated (10x over 1 min) noxious heat or cotton bud strokes applied to the affected site or contralaterally. Tactile stimulation of the affected area evoked pain (median 7 NRS) and a reduction (>30%) in the area of allodynia in 9/18 patients (maximum -48+/-9%, after 20 min), although the intensity of allodynic pain was unchanged. This effect persisted for over 1h and was present the following day in all patients tested (n=5/5). No subjects showed an increase in area after allodynic stimulation. There was no change in heat pain threshold at a distant site following allodynic stimulation, suggesting no activation of diffuse noxious inhibitory control. Repeated thermal noxious stimulation (median NRS 7) could also elicit changes (>30%) in the area of allodynia in some patients (reductions in 7/20, increases in 3/20). Thus, we have found that a brief period of homotopic painful stimulation can reduce the area of allodynia in around half of patients with established neuropathic pains.
Keywords AdultAgedAged, 80 and overFemaleHumansHyperalgesia/physiopathology/*therapyMaleMiddle AgedNeural Inhibition/physiologyNociceptors/*physiologyPain MeasurementPain Threshold/physiologyPeripheral Nerves/physiopathologyPeripheral Nervous System Diseases/physiopathology/*therapyPhysical Stimulation*Physical Therapy ModalitiesSkin/innervation/physiopathologyTouch/*physiologyTreatment Outcome
PMID: 19117776
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LOVE-JONES, Sarah J. et al. Homotopic stimulation can reduce the area of allodynia in patients with neuropathic pain. In: European Journal of Pain, 2009, vol. 13, n° 9, p. 942-948. doi: 10.1016/j.ejpain.2008.11.018 https://archive-ouverte.unige.ch/unige:19478

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Deposited on : 2012-04-23

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