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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Neurology 1/2017

Ipsilateral and contralateral sensory changes in healthy subjects after experimentally induced concomitant sensitization and hypoesthesia

Zeitschrift:
BMC Neurology > Ausgabe 1/2017
Autoren:
Elena K. Enax-Krumova, Stephanie Pohl, Andrea Westermann, Christoph Maier
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12883-017-0839-9) contains supplementary material, which is available to authorized users.

Abstract

Background

In unilateral neuropathic pain. e.g. after peripheral nerve injury, both positive and negative sensory signs occur often, accompanied by minor but equally directed contralateral sensory changes. To mimic this feature, we experimentally aimed to induce concomitant c-fibre sensitization and block in healthy subjects and analyzed the bilateral sensory changes by quantitative sensory testing (QST) using the protocol of the German Research Network on Neuropathic Pain.

Methods

Twenty eight healthy subjects were firstly randomized in 2 groups to receive either topical capsaicin (0.6%, 12 cm2, application duration: 15 min.) or a lidocaine/prilocaine patch (25/25 mg, 10 cm2, application duration: 60 min.) on the right volar forearm. Secondly, 7–14 days later in the same area either at first capsaicin (for 15 min.) and immediately afterwards local anesthetics (for 60 min.) was applied (Cap/LA), or in inversed order with the same application duration (LA/Cap). Before, after each application and 7–14 days later a QST was performed bilaterally. Statistics: Wilcoxon-test, ANOVA, p < 0.05.

Results

Single application of 0,6% capsaicin induced thermal hypoesthesia, cold hypoalgesia, heat hyperalgesia and tactile allodynia. Lidocaine/prilocaine alone induced thermal and tactile hypoesthesia as well as mechanical and cold hypoalgesia, and a heat hyperalgesia (to a smaller extent). Ipsilaterally both co-applications induced a combination of the above mentioned changes. Significant contralateral sensory changes occurred only after the co-application with concomitant sensitization and hypoesthesia and comprised increased cold (Cap/LA, LA/Cap) and mechanical detection as well as cold pain threshold (LA/Cap).

Conclusion

The present experimental model using combined application of capsaicin and LA imitates partly the complex sensory changes observed in patients with unilateral neuropathic pain and might be used as an additional surrogate model. Only the concomitant use both agents in the same area induces both positive and negative sensory signs ipsilaterally as well as parallel contralateral sensory changes (to a lesser extent).

Trial registration

ClinicalTrials.gov Identifier NCT01540877, registered on 23 February 2012.
Zusatzmaterial
Additional file 1: Table S1. A. QST data after single substance application (site of application; data are presented as median (range)). B. QST data after combined substance application (site of application; data are presented as median (range)). (DOCX 35 kb)
12883_2017_839_MOESM1_ESM.docx
Additional file 2: Table S2. A. QST data after single substance application (contralateral to the application site; data are presented as median (range)). B. QST data after combined substance application (contralateral to the application site; data are presented as median (range)). (DOCX 34 kb)
12883_2017_839_MOESM2_ESM.docx
Additional file 3: Figure S1. (A) Contralateral changes in the cold detection threshold of all subjects before and after application of a combination of capsaicin and local anesthetics as well as 7-14 days later. (B) Contralateral changes in the mechanical detection threshold of all subjects before and after application of capsaicin and local anesthetics as well as 7–14 days later. Gray circuits show the calculated group means. Red borders indicate significant changes. (TIF 1022 kb)
12883_2017_839_MOESM3_ESM.tif
Literatur
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