Abstract
Pain is the most common patient complaint encountered by practitioners in the outpatient setting. At times, the diagnosis and treatment of a given pain syndrome can be challenging due to its subjective nature. Besides the physical examination, there are several methods for quantifying and measuring pain and sensory nerve fiber outputs. In the 1940s, a logical approach to the sensory examination was identified with defined surface areas highly correlated with specific anatomic dermatomes. These dermatomes are associated with specific nerve roots and are very useful for the clinician attempting to ascertain the source of a pain generator. The concept of current perception threshold was later developed to measure the degree of sensory deficit. There was significant variability associated with this diagnostic technique, which involved changing skin resistance. These limitations led to further evolution and development of sensory conduction testing. It is important to know the evolution of nerve testing and to differentiate small-pain-fibers method of testing from previous techniques. This chapter discusses sensory nerve conduction threshold testing and the small pain fibers method of sensory nerve interrogation.
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Selected References
Abrams BM, Waldman HJ. Electromyography and evoked potentials. In: Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE, editors. Raj’s practical management of pain. Philadelphia: Mosby Elsevier; 2008. p. 189–216.
Adriaensen H, Gybels J, Handwerker HO, Van Hees J. Response properties of thin myelinated (A-δ) fibers in human skin nerves. J Neurophysiol. 1983;49(1):111–22.
Alo K, Chado H. Effect of spinal cord stimulation on sensory nerve conduction threshold functional measures. Neuromodulation. 2000;3(3):145–54. https://doi.org/10.1046/j.1525-1403.2000.00145.x. ISSN 10947159. PMID 22151462.
American Association of Electrodiagnostic Medicine. Technology review: the neurometer current perception threshold (CPT). Muscle Nerve. 1999;22:523–31.
Cabanes-Martinez L, Valera C, del Mar Moreno-Galera M, Palomeque GM, Blas G, Antón M, et al. S168. Intraoperative neurophysiologic monitoring in spinal cord lesions: from the experimental study to the operating room. Clin Neurophysiol. 2018;129(Suppl 1):e204–5.
Chado HN. The current perception threshold evaluation of sensory nerve function in pain management. Pain Digest. 1995;5:127–34.
Cork RC, Saleemi S, Hernandez L, Schult T, Brandt S. Predicting nerve root pathology with voltage-actuated sensory nerve conduction threshold. Internet J Pain Symptom Control Palliat Care. 2002;2(2). http://ispub.com/IJN/2/1/3519.
Gasparotti R, Padua L, Briani C, Lauria G. New technologies for the assessment of neuropathies. Nat Rev Neurol. 2017;13:203–16.
Hedgecock J. Textbook of pain electrodiagnosis – evidence based medicine. Laguna Beach: AASEM; 2012.
Laratta JL, Ha A, Shillingford JN, Makhni MC, Lombardi JM, Thuet E, et al. Neuromonitoring in spinal deformity surgery: a multimodality approach. Global Spine J. 2018a;8(1):68–77. Published online 2017 May 31. https://doi.org/10.1177/2192568217706970. PMCID: PMC5810893. PMID: 29456917.
Laratta JL, Shillingford JN, Ha A, Lombardi JM, Reddy HP, Saifi C, et al. Utilization of intraoperative neuromonitoring throughout the United States over a recent decade: an analysis of the nationwide inpatient sample. J Spine Surg. 2018b;4(2):211–9.
Lauria G, Bakkers M, Schmitz C, Lombardi R, Penza P, Devigili G, et al. Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study. J Peripher Nerv Sys. 2010;15:202–7.
Massaquoi R, Kafaie J, Kumar A, Chen PW, Naeem A. A comparison of different laboratory and clinical findings in small fiber neuropathy (SFN). Neurology. 2018;15:456.
McArthur JC, Stocks EA, Hauer P, Cornblath DR, Griffin JW. Epidermal nerve fiber density: normative reference range and diagnostic efficiency. Arch Neurol. 1998;55:1513–20.
Nunes RR, Bersot CDA, Garritano JG. Intraoperative neurophysiological monitoring in neuroanesthesia. Curr Opin Anaesthesiol. 2018; https://doi.org/10.1097/ACO.0000000000000645.
Sandkühler J, Chen JG, Cheng G, Randić M. Low-frequency stimulation of afferent Aδ-fibers induces long-term depression at primary afferent synapses with substantia gelatinosa neurons in the rat. J Neurosci. 1997;17(16):6483–91.
Simioni V, Capone JG, Sette E, Granieri E, Farneti M, Cavallo MA, et al. Intraoperative monitoring of sensory part of the trigeminal nerve using blink reflex during microvascular decompression for trigeminal neuralgia. Acta Neurochir. 2018;160(1):165–9.
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Kaye, A.D., Prabhakar, A., Novitch, M.B., Renschler, J.S., Cornett, E.M. (2020). New Vistas: Intraoperative Neurophysiological Monitoring and Small-Pain-Fibers Method of Testing for Spinal Cord Assessment in Pain States. In: Davis, S., Kaye, A. (eds) Principles of Neurophysiological Assessment, Mapping, and Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-22400-4_23
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DOI: https://doi.org/10.1007/978-3-030-22400-4_23
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