Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T09:33:04.205Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of the clinical relevance of quantitative sensory testing with Von Frey monofilaments in patients with allodynia and neuropathic pain. A pilot study

Published online by Cambridge University Press:  01 August 2007

D. Keizer ,
M. van Wijhe ,
W. J. Post ,
D. R. A. Uges  and
J. M. K. H. Wierda
D. Keizer*
Affiliation:
University Medical Center Groningen, Pain Management Center, Department of Anesthesiology, The Netherlands
M. van Wijhe
Affiliation:
University Medical Center Groningen, Pain Management Center, Department of Anesthesiology, The Netherlands
W. J. Post
Affiliation:
Office for Medical Technology Assessment
D. R. A. Uges
Affiliation:
Department of Pharmacy, The Netherlands
J. M. K. H. Wierda
Affiliation:
University Medical Center Groningen, Pain Management Center, Department of Anesthesiology, The Netherlands
*
Correspondence to: Doeke Keizer, Department of Anesthesiology, Pain Management Center, University Medical Center Groningen, P. O. Box 30001,9700 RB Groningen, The Netherlands. E-mail: d.keizer@anest.umcg.nl; Tel:+31 050 3614886; Fax: +31 050 3619317
Get access

Summary

Background

Allodynia is a common and disabling symptom in many patients with neuropathic pain. Whereas quantification of pain mostly depends on subjective pain reports, allodynia can also be measured objectively with quantitative sensory testing. In this pilot study, we investigated the clinical relevance of quantitative sensory testing with Von Frey monofilaments in patients with allodynia as a consequence of a neuropathic pain syndrome, by means of correlating subjective pain scores with pain thresholds obtained with quantitative sensory testing.

Methods

During a 4-week trial, we administered a cannabis extract to 17 patients with allodynia. We quantified the severity of the allodynia with Von Frey monofilaments before, during and after the patients finished the trial. We also asked the patients to rate their pain on a numeric rating scale at these three moments.

Results

We found that most of the effect of the cannabis occurred in the last 2 weeks of the trial. In this phase, we observed that the pain thresholds, as measured with Von Frey monofilaments, were inversely correlated with a decrease of the perceived pain intensity.

Conclusion

These preliminary findings indicate clinical relevance of quantitative sensory testing with Von Frey monofilaments in the quantification of allodynia in patients with neuropathic pain, although confirmation of our data is still required in further studies to position this method of quantitative sensory testing as a valuable tool, for example, in the evaluation of therapeutic interventions for neuropathic pain.

Keywords

ALLODYNIAVON FREY MONOFILAMENTSQSTNEUROPATHIC PAIN; CANNABIS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 8 , August 2007 , pp. 658 - 663
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Macres, SM, Richeimer, SH, Duran, PJ. The pathophysiology and treatment of neuropathic pain. Am Soc Anesthesiol 1999; 27: 109–121.Google Scholar
2.Woolf, CJ, Mannion, RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet 1999; 353: 1959–1964.CrossRefGoogle ScholarPubMed
3.Bridges, D, Thompson, SWN, Rice, ASC. Mechanisms of neuropathic pain. Br J Anaesth 2001; 87: 12–26.CrossRefGoogle ScholarPubMed
4.Merskey, H, Bogduk, N. eds. Classification of chronic pain. Seattle: IASP Press, 1994.Google Scholar
5.Hansson, PT, Lacerenza, M, Marchettini, P. Aspects of clinical and experimental neuropathic pain: the clinical perspective In: Hansson, PT, Fields, HL, Hill, RG, Marchettini, P. eds. Neuropathic Pain: Pathophysiology and Treatment, Progress in Pain Research and Management, Vol. 21. Seattle: IASP Press, 2001: 1–18.Google Scholar
6.Backonja, MM. Painful neuropathies In: Loeser, JD. ed. Bonica’s Management of Pain. Philadelphia: Lippincott Williams & Wilkins, 2002: 371–387.Google Scholar
7.Chapman, CR, Syrjala, KL. Measurement of pain In: Bonica, JJ. ed. The management of pain. Philadelphia: Lea & Febiger, 1990: 580–594.Google Scholar
8.Atcheson, R. Physiology and measurement of pain In: Aitkenhead, AR, Rowbotham, DJ, Smith, G. eds. Textbook of anaesthesia. London: Churchill Livingstone, 2001: 201–210.Google Scholar
9.Edwards, RR, Sarlani, E, Wesselmann, U, Fillingim, RB. Quantitative assessment of experimental pain perception: multiple domains of clinical relevance. Pain 2005; 114: 315–319.CrossRefGoogle ScholarPubMed
10.Peripheral Neuropathy Association. Quantitative sensory testing: a consensus report from the peripheral neuropathy association. Neurology 1993; 43: 1050–1052.CrossRefGoogle Scholar
11.Keizer, D, Wijhe van, M, Post, WJ, Wierda, JMKH. Quantifying allodynia in patients suffering from unilateral neuropathic pain using Von Frey monofilaments. Clin J Pain 2007; 23: 85–90.CrossRefGoogle ScholarPubMed
12.Bell-Krotoski, J, Tomancik, E. The repeatability of testing with Semmes–Weinstein monofilaments. J Hand Surg 1987; 12A: 155–161.CrossRefGoogle Scholar
13.Mikkelsen, T, Werner, MU, Lassen, B, Kehlet, H. Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy. Anaesth Analg 2004; 99: 146–151.CrossRefGoogle ScholarPubMed
14.Campbell, FA, Tramèr, MR, Carroll, D, Reynolds, DJM, Moore, RA, McQuay, HJ. Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. BMJ 2001; 323: 1–6.CrossRefGoogle Scholar
15.Kumar, RN, Chambers, WA, Pertwee, RG. Pharmacological actions and therapeutic uses of cannabis and cannabinoids. Anaesthesia 2001; 56: 1059–1068.CrossRefGoogle ScholarPubMed
16.Iversen, L, Chapman, V. Cannabinoids: a real prospect for pain relief? Cur Opin Pharmacol 2002; 2: 50–55.CrossRefGoogle ScholarPubMed
17.Rukwied, R, Watkinson, A, McGlone, F, Dvorak, M. Cannabinoid agonists attenuate capsaicin-induced responses in human skin. Pain 2003; 102: 283–288.CrossRefGoogle ScholarPubMed
18.Voerman, VF, Egmond van, J, Crul, BJP. Elevated detection thresholds for mechanical stimuli in chronic pain patients: support for a central mechanism. Arch Phys Med Rehabil 2000; 81: 430–435.CrossRefGoogle ScholarPubMed
19.Price, DD, Bennett, GJ, Raffii, A. Psychophysical observations on patients with neuropathic pain relieved by a sympathetic block. Pain 1989; 36: 273–288.CrossRefGoogle ScholarPubMed
20.Gruener, G, Dyck, PJ. Quantitative sensory testing: methodology, application, and future directions. J Clin Neurophysiol 1994; 11: 568–583.CrossRefGoogle ScholarPubMed
21.Dotson, RM. Clinical neurophysiology laboratory tests to assess the nociceptive system in humans. J Clin Neurophysiol 1997; 14: 32–45.CrossRefGoogle ScholarPubMed
22.Sorensen, J, Bengtsson, A, Ahlner, J, Henriksson, KG, Ekselius, L, Bengtsson, M. Fibromyalgia – are there different mechanisms in the processing of pain? A double blind crossover comparison of analgesic drugs. J Rheumatol 1997; 24: 1615–1621.Google Scholar
23.Martin, WJ, Loo, CM, Basbaum, AI. Spinal cannabinoids are anti-allodynic in rats with persistent inflammation. Pain 1999; 82: 199–205.CrossRefGoogle ScholarPubMed
24.Farquhar-Smith, WP. Pain and cannabinoids: science and evidence. Pain Reviews 2002; 9: 41–67.CrossRefGoogle Scholar
25.Mather, LE. Medicinal cannabis – Hoax or hope? Reg Anesth Pain Med 2001; 26: 484–487.CrossRefGoogle ScholarPubMed