Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
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Randomized Controlled Trial Comparative Study
A new clinical scale to grade the impairment of median nerve in carpal tunnel syndrome.
In carpal tunnel syndrome (CTS) distribution of paresthesias is related to the degree of the nerve impairment. To improve the clinical ability in detecting the damage severity, we have introduced the criteria "distribution of paresthesias" in a previous clinical scale: the historical-objective scale (Hi-Ob). ⋯ The new scale may be useful in routine examination and for scientific purposes.
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Comparative Study
A search for activation of C nociceptors by sympathetic fibers in complex regional pain syndrome.
Although the term 'reflex sympathetic dystrophy' has been replaced by 'complex regional pain syndrome' (CRPS) type I, there remains a widespread presumption that the sympathetic nervous system is actively involved in mediating chronic neuropathic pain ["sympathetically maintained pain" (SMP)], even in the absence of detectable neuropathophysiology. ⋯ This study shows that sympathetic-nociceptor interactions, if they exist in patients communicating chronic neuropathic pain, must be the exception.
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Comparative Study
Motor cortex dysfunction in complex regional pain syndrome.
Most patients with complex regional pain syndrome (CRPS) exhibit debilitating motor symptoms. The effect of continuous pain on motor system in CRPS, however, is not well known. We searched for signs of motor cortex dysfunction in chronic CRPS type 1 patients with motor impairment. ⋯ Abnormal motor cortex reactivity may be linked with motor dysfunction of the affected hand in CRPS.
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The nociceptive blink reflex is a trigeminofacial brain-stem reflex which is used in pain research to evaluate the modulation of pain processing. To standardize the analysis of the reflex we investigated which electromyographic parameters show the best correlation with subjective pain ratings and should therefore be used for scoring blink reflex magnitude. Furthermore we investigated which parameters show the highest accuracy and reliability to define the blink reflex threshold. ⋯ The here defined standardized criteria to score blink reflex magnitude and threshold improve the comparability and validity of blink reflex studies.
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To assess the modulation of acute provoked pain by repetitive transcranial magnetic stimulation (rTMS) of the motor cortex in patients with chronic neuropathic pain. ⋯ Previous studies have shown that rTMS delivered to various cortical targets by different protocols could modulate experimental pain, primarily in healthy subjects. The present results demonstrate the ability of motor cortex rTMS to interfere with the processing of acute provoked pain, even if there is an underlying chronic neuropathic pain.