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Nociceptive two-point discrimination acuity and body representation failure in polyneuropathy
Livia Steenken1, Rodrigo M Conde1,2, Julia K Müller1
1Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Scandinavian Journal of Pain
|August 3, 2022
Summary
Diagnosing polyneuropathy (PNP) and neuropathic pain can be challenging. Assessing two-point discrimination thresholds (2ptDT) for pinprick stimuli, particularly on the hands, and evaluating foot size perception aids in accurate PNP diagnosis.
Area of Science:
- Neurology
- Pain Medicine
- Sensory Neuroscience
Background:
- Clinical diagnosis of polyneuropathy (PNP) and neuropathic pain can be difficult when routine investigations are inconclusive.
- Sensory testing, including two-point discrimination thresholds (2ptDT), and body representation assessment may help bridge this diagnostic gap.
Purpose of the Study:
- To evaluate the utility of 2ptDT and body representation disturbances in diagnosing PNP and neuropathic pain.
- To identify specific sensory tests and perceptual measures that can differentiate patients with PNP from healthy individuals.
Main Methods:
- Compared 2ptDT for pinprick and laser-heat pain, along with perception thresholds, in 20 PNP patients and 20 healthy controls.
- Assessed body representation disturbances using self-estimated foot size and a modified Bath CRPS body perception disturbances questionnaire.
Main Results:
- Patients with PNP exhibited higher 2ptDT for pinprick stimuli, especially on the hands, compared to controls.
- Multivariate analysis using 2ptDT (pinprick hands, laser-heat feet) and laser-heat perception thresholds (feet) correctly classified 85% of PNP vs. healthy controls.
- A combination of 2ptDT (pinprick hands), pinprick perception thresholds (calves), and foot length estimation distinguished painful from non-painful PNP with 90% accuracy.
Conclusions:
- Testing 2ptDT for painful pinprick stimuli on the hands is a valuable tool for diagnosing PNP.
- Incorporating foot length estimation alongside specific sensory tests can enhance diagnostic accuracy for painful PNP.
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