Somatosensory Rehabilitation of Pain
Encyclopedia
The Somatosensory Rehabilitation of Pain, is a method, who’s aim is to treat conditions of a reduced sense of touch or sensation (hypoesthesia
) in order to decrease neuropathic pain
. Neuropathic pain, with a prevalency of 6.9 % of the general population, represents an important public health problem. i.e. Carpal Tunnel Syndrome (CTS) concerns 2.7% of the general population.; i.e. Complex Regional Pain Syndrome (CRPS) concerns 26/100,000 person-years of the general population.
. In 1872, after the American Civil War
the American neurologist Silas Weir Mitchell
was the first to observe the correlation between the altered cutaneous fibres and the burning pain that he named causalgia. For him the cohabitation of altered cutaneous fibres and non-altered was the etiology of this neuropathic pain symptom. In 1909, the British surgeons Wilfred Trotter and H. Morriston Davies studied on volunteers (themselves) the sensory recovery in altered sensibility of the skin. In 1915, during World War I
the German surgeon Paul Hoffmann and the French neurologist Jules Tinel discovered a sign of sensory recovery: the Hoffmann-Tinel or Tinel sign. In 1954, after World War II
, a council of surgeons defined a classification of sensory recovery. In 1978, the hand surgeon A Lee Dellon created a new tool to follow the sensory recovery: the moving 2-point discrimination test. In 1981, he published his first Textbook about the testing after nerve injury and repair and was the first to propose a re-education of sensibility. In 1997, he made his concept more clear by proposing a new title for his Textbook: Somatosensory Testing and Rehabilitation. In 1998, Birgit Rosen and Göran Lundborg created a new tool to test altered sensibility. They proposed a multisensory treatment (auditive and somatosensory sense) and published their papers as sensory relearning. Somatosensory testing is simultaneously testing and rehabilitation. To make the concept more clear, Claude J. Spicher proposed, in 2006, the concept of somatosensory rehabilitation. As the somatosensory system is considered as the centre of one of the etiologies of neuropathic pain Spicher proposed to switch the concept, in the French version of WIKIPEDIA :fr:Rééducation sensitive de la douleur the concept of Somatosensory Rehabilitation into Somatosensory Rehabilitation of Pain, in order to enlighten the aim of this method, which is to reduce neuropathic pain. In 1979, Ulf Lindblom – at that time the president of International Association for the Study of Pain
- insisted on the fact that pain itself is the centre of concern for both the patient and the physician but the sensory abnormalities which often occur in the painful area are important as well.
decreases.
The assessment of partial hypoaesthesia (axonotmesis) is based on the concept of the largest cutaneous distribution of the nerve branch. The first phase is the mapping which outlines the hypoaesthetic territory - aesthesiography
. The second phase is the regular and rigorous assessment of the quality of hypoesthesia in terms of pressure perception threshold. This is an important part of this rehabilitation.
Sometimes, the hypoaesthetic territory is masked by a patch of skin which is painful to touch and is therefore not accessible. Since 1979, this stimulus induced pain is to be called allodynia
in medicine. The original definition comes from Merksey and Bogduk (1994) “pain due to a stimulus which does not normally provoke pain”. In such situations, while doing the diagnostic testing of axonal lesions at the first occupational or physical therapy session, the two point discrimination test is impossible, because it induces pain.“This conflict between hypersensitivity and hypoaesthesia is commonly seen in the clinical setting in patients with CRPS”.
The presence of mechanical allodynia
, hinders other physical treatments. For the reason that, any contact on the hypersensitive territory, although it can be bearable in the moment, can induce several hours of a very painful post-effect or even several sleepless nights. This hypersensitivity to touch is induced by the peripheral nerve lesion of the large myelinated A-beta fibers.
In other words, after a peripheral nerve lesion, aberrant sprouting occurs in the dorsal horn which can explain that a non-noxious stimulus is perceived as being noxious. This is one of the explanatory models of the different mechanisms of central sensitization.
Switzerland and has, since 2000 expanded to Europe, North of America, Argentina and Australia http://www.unifr.ch/neuro/rouiller/somesthesie/enews2011/e-News%208(2).pdf#page=7.
– Distant Vibrotactile Counter Stimulation – Perception Pressure Threshold – McGill Pain Questionnaire
– Neuropathic pain
Hypoesthesia
Hypoesthesia refers to a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli....
) in order to decrease neuropathic pain
Neuropathic pain
Neuropathic pain results from lesions or diseases affecting the somatosensory system. It may be associated with abnormal sensations called dysesthesia, which occur spontaneously and allodynia that occurs in response to external stimuli. Neuropathic pain may have continuous and/or episodic ...
. Neuropathic pain, with a prevalency of 6.9 % of the general population, represents an important public health problem. i.e. Carpal Tunnel Syndrome (CTS) concerns 2.7% of the general population.; i.e. Complex Regional Pain Syndrome (CRPS) concerns 26/100,000 person-years of the general population.
History
In 1869, the French surgeon Jean Joseph Emile Létiévant was the first to map the altered sensibility of the cutaneous sense : aesthesiographyAesthesiography
Aesthesiography comes from the Greek word “aesthesis” meaning "sensibility," and “graphy” in order to visualize hyposensibility of the skin. This term has been proposed by the French surgeon Létiévant....
. In 1872, after the American Civil War
American Civil War
The American Civil War was a civil war fought in the United States of America. In response to the election of Abraham Lincoln as President of the United States, 11 southern slave states declared their secession from the United States and formed the Confederate States of America ; the other 25...
the American neurologist Silas Weir Mitchell
Silas Weir Mitchell
Silas Weir Mitchell was an American physician and writer.He was son of a physician, John Kearsley Mitchell , and was born in Philadelphia, Pennsylvania....
was the first to observe the correlation between the altered cutaneous fibres and the burning pain that he named causalgia. For him the cohabitation of altered cutaneous fibres and non-altered was the etiology of this neuropathic pain symptom. In 1909, the British surgeons Wilfred Trotter and H. Morriston Davies studied on volunteers (themselves) the sensory recovery in altered sensibility of the skin. In 1915, during World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
the German surgeon Paul Hoffmann and the French neurologist Jules Tinel discovered a sign of sensory recovery: the Hoffmann-Tinel or Tinel sign. In 1954, after World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
, a council of surgeons defined a classification of sensory recovery. In 1978, the hand surgeon A Lee Dellon created a new tool to follow the sensory recovery: the moving 2-point discrimination test. In 1981, he published his first Textbook about the testing after nerve injury and repair and was the first to propose a re-education of sensibility. In 1997, he made his concept more clear by proposing a new title for his Textbook: Somatosensory Testing and Rehabilitation. In 1998, Birgit Rosen and Göran Lundborg created a new tool to test altered sensibility. They proposed a multisensory treatment (auditive and somatosensory sense) and published their papers as sensory relearning. Somatosensory testing is simultaneously testing and rehabilitation. To make the concept more clear, Claude J. Spicher proposed, in 2006, the concept of somatosensory rehabilitation. As the somatosensory system is considered as the centre of one of the etiologies of neuropathic pain Spicher proposed to switch the concept, in the French version of WIKIPEDIA :fr:Rééducation sensitive de la douleur the concept of Somatosensory Rehabilitation into Somatosensory Rehabilitation of Pain, in order to enlighten the aim of this method, which is to reduce neuropathic pain. In 1979, Ulf Lindblom – at that time the president of International Association for the Study of Pain
International Association for the Study of Pain
The International Association for the Study of Pain is an international professional organization promoting research, education and policies for the knowledge and management of pain. The IASP was founded in 1973, following the Seattle-Issaquah conference, under the leadership of John Bonica. Its...
- insisted on the fact that pain itself is the centre of concern for both the patient and the physician but the sensory abnormalities which often occur in the painful area are important as well.
The Somatosensory Rehabilitation Method
The aim of somatosensory rehabilitation is to increase the quality of touch or even normalize the sensation of touch in the case of neuropathic pain due to peripheral nerve lesions. Because, when hypoesthesia decreases, neuropathic painNeuropathic pain
Neuropathic pain results from lesions or diseases affecting the somatosensory system. It may be associated with abnormal sensations called dysesthesia, which occur spontaneously and allodynia that occurs in response to external stimuli. Neuropathic pain may have continuous and/or episodic ...
decreases.
The assessment of partial hypoaesthesia (axonotmesis) is based on the concept of the largest cutaneous distribution of the nerve branch. The first phase is the mapping which outlines the hypoaesthetic territory - aesthesiography
Aesthesiography
Aesthesiography comes from the Greek word “aesthesis” meaning "sensibility," and “graphy” in order to visualize hyposensibility of the skin. This term has been proposed by the French surgeon Létiévant....
. The second phase is the regular and rigorous assessment of the quality of hypoesthesia in terms of pressure perception threshold. This is an important part of this rehabilitation.
Sometimes, the hypoaesthetic territory is masked by a patch of skin which is painful to touch and is therefore not accessible. Since 1979, this stimulus induced pain is to be called allodynia
Allodynia
Allodynia is a pain due to a stimulus which does not normally provoke pain. Temperature or physical stimuli can provoke allodynia, and it often occurs after injury to a site...
in medicine. The original definition comes from Merksey and Bogduk (1994) “pain due to a stimulus which does not normally provoke pain”. In such situations, while doing the diagnostic testing of axonal lesions at the first occupational or physical therapy session, the two point discrimination test is impossible, because it induces pain.“This conflict between hypersensitivity and hypoaesthesia is commonly seen in the clinical setting in patients with CRPS”.
The presence of mechanical allodynia
Allodynia
Allodynia is a pain due to a stimulus which does not normally provoke pain. Temperature or physical stimuli can provoke allodynia, and it often occurs after injury to a site...
, hinders other physical treatments. For the reason that, any contact on the hypersensitive territory, although it can be bearable in the moment, can induce several hours of a very painful post-effect or even several sleepless nights. This hypersensitivity to touch is induced by the peripheral nerve lesion of the large myelinated A-beta fibers.
In other words, after a peripheral nerve lesion, aberrant sprouting occurs in the dorsal horn which can explain that a non-noxious stimulus is perceived as being noxious. This is one of the explanatory models of the different mechanisms of central sensitization.
Teaching
The Center where this method has started being practiced is in FribourgFribourg
Fribourg is the capital of the Swiss canton of Fribourg and the district of Sarine. It is located on both sides of the river Saane/Sarine, on the Swiss plateau, and is an important economic, administrative and educational center on the cultural border between German and French Switzerland...
Switzerland and has, since 2000 expanded to Europe, North of America, Argentina and Australia http://www.unifr.ch/neuro/rouiller/somesthesie/enews2011/e-News%208(2).pdf#page=7.
Keywords
AllodyniaAllodynia
Allodynia is a pain due to a stimulus which does not normally provoke pain. Temperature or physical stimuli can provoke allodynia, and it often occurs after injury to a site...
– Distant Vibrotactile Counter Stimulation – Perception Pressure Threshold – McGill Pain Questionnaire
McGill Pain Questionnaire
The McGill Pain Questionnaire, also known as McGill pain index, is a scale of rating pain developed at McGill University by Melzack and Torgerson in 1971....
– Neuropathic pain
Neuropathic pain
Neuropathic pain results from lesions or diseases affecting the somatosensory system. It may be associated with abnormal sensations called dysesthesia, which occur spontaneously and allodynia that occurs in response to external stimuli. Neuropathic pain may have continuous and/or episodic ...
See also
- AesthesiographyAesthesiographyAesthesiography comes from the Greek word “aesthesis” meaning "sensibility," and “graphy” in order to visualize hyposensibility of the skin. This term has been proposed by the French surgeon Létiévant....
- AllodyniaAllodyniaAllodynia is a pain due to a stimulus which does not normally provoke pain. Temperature or physical stimuli can provoke allodynia, and it often occurs after injury to a site...
- Complex Regional Pain SyndromeComplex regional pain syndromeComplex regional pain syndrome is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. It often affects an arm or a leg and may spread to another part of the body.Though treatment is often unsatisfactory, early multimodal therapy can cause dramatic...
- Cutaneous innervationCutaneous innervationCutaneous innervation refers to the area of the skin which is supplied by a specific cutaneous nerve.Dermatomes are similar; however, a dermatome only specifies the area served by a spinal nerve...
- HyperesthesiaHyperesthesiaHyperesthesia is a condition that involves an abnormal increase in sensitivity to stimuli of the sense. "When a non-noxious stimulus causes the sensation of pain the area will be termed hyperaesthetic". Stimuli of the senses can include sound that one hears, foods that one tastes, textures that...
- NeuralgiaNeuralgiaNeuralgia is pain in one or more nerves that occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central...
- Neuropathic painNeuropathic painNeuropathic pain results from lesions or diseases affecting the somatosensory system. It may be associated with abnormal sensations called dysesthesia, which occur spontaneously and allodynia that occurs in response to external stimuli. Neuropathic pain may have continuous and/or episodic ...
- NeuroplasticityNeuroplasticityNeuroplasticity is a non-specific neuroscience term referring to the ability of the brain and nervous system in all species to change structurally and functionally as a result of input from the environment. Plasticity occurs on a variety of levels, ranging from cellular changes involved in...
- Somatosensory systemSomatosensory systemThe somatosensory system is a diverse sensory system composed of the receptors and processing centres to produce the sensory modalities such as touch, temperature, proprioception , and nociception . The sensory receptors cover the skin and epithelia, skeletal muscles, bones and joints, internal...
- Somatosensory & Motor ResearchSomatosensory & Motor ResearchSomatosensory & Motor Research is a peer-reviewed medical journal that covers all topics relating to the neural bases for somatic sensation, somatic motor function, somatic motor integration, and modeling thereof. The journal has been published quarterly by Informa since 1983...