Homotopic stimulation can reduce the area of allodynia in patients with neuropathic pain
|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||Adult — Aged — Aged, 80 and over — Female — Humans — Hyperalgesia/physiopathology/*therapy — Male — Middle Aged — Neural Inhibition/physiology — Nociceptors/*physiology — Pain Measurement — Pain Threshold/physiology — Peripheral Nerves/physiopathology — Peripheral Nervous System Diseases/physiopathology/*therapy — Physical Stimulation — *Physical Therapy Modalities — Skin/innervation/physiopathology — Touch/*physiology — Treatment Outcome|
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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|