No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy

Julia Forstenpointner; Ruth Ruscheweyh; Nadine Attal; Ralf Baron; Didier Bouhassira; Elena K. Enax-Krumova; Nanna B. Finnerup; Rainer Freynhagen; Janne Gierthmühlen; Per Hansson; Troels S. Jensen; Christoph Maier; Andrew S.C. Rice; Märta Segerdahl; Thomas Tölle; Rolf Detlef Treede; Jan Vollert

doi:10.1097/j.pain.0000000000002058

No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy

Julia Forstenpointner, Ruth Ruscheweyh, Nadine Attal, Ralf Baron, Didier Bouhassira, Elena K. Enax-Krumova, Nanna B. Finnerup, Rainer Freynhagen, Janne Gierthmühlen, Per Hansson, Troels S. Jensen, Christoph Maier, Andrew S.C. Rice, Märta Segerdahl, Thomas Tölle, Rolf Detlef Treede, Jan Vollert

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Abstract

ABSTRACT: The pathophysiology of pain in neuropathy is complex and may be linked to sensory phenotypes. Quantitative sensory testing, a standardized method to evaluate sensory profiles in response to defined stimuli, assesses functional integrity of small and large nerve fiber afferents and central somatosensory pathways. It has revealed detailed insights into mechanisms of neuropathy, yet it remains unclear if pain directly affects sensory profiles. The main objective of this study was to investigate sensory profiles in patients with various neuropathic conditions, including polyneuropathy, mononeuropathy, and lesions to the central nervous system, in relation to self-reported presence or absence of pain and pain sensitivity using the Pain Sensitivity Questionnaire. A total of 443 patients (332 painful and 111 painless) and 112 healthy participants were investigated. Overall, loss of sensation was equally prevalent in patients with and without spontaneous pain. Pain thresholds were equally lowered in both patient groups, demonstrating that hyperalgesia and allodynia are just as present in patients not reporting any pain. Remarkably, this was similar for dynamic mechanical allodynia. Hypoalgesia was more pronounced in painful polyneuropathy, whereas hyperalgesia was more frequent in painful mononeuropathy (compared with painless conditions). Self-reported pain sensitivity was significantly higher in painful than in painless neuropathic conditions. Our results reveal the presence of hyperalgesia and allodynia in patients with central and peripheral lesions of the somatosensory system not reporting spontaneous pain. This shows that symptoms and signs of hypersensitivity may not necessarily coincide and that painful and painless neuropathic conditions may mechanistically blend into one another.

Original language	English
Journal	Pain
Volume	162
Issue	3
Pages (from-to)	718-727
Number of pages	10
ISSN	0304-3959
DOIs	https://doi.org/10.1097/j.pain.0000000000002058
Publication status	Published - Mar 2021

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Forstenpointner, J., Ruscheweyh, R., Attal, N., Baron, R., Bouhassira, D., Enax-Krumova, E. K., Finnerup, N. B., Freynhagen, R., Gierthmühlen, J., Hansson, P., Jensen, T. S., Maier, C., Rice, A. S. C., Segerdahl, M., Tölle, T., Treede, R. D., & Vollert, J. (2021). No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy. Pain, 162(3), 718-727. https://doi.org/10.1097/j.pain.0000000000002058

@article{52cf038a109b482daefbce71c81d7ada,

title = "No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy",

abstract = "ABSTRACT: The pathophysiology of pain in neuropathy is complex and may be linked to sensory phenotypes. Quantitative sensory testing, a standardized method to evaluate sensory profiles in response to defined stimuli, assesses functional integrity of small and large nerve fiber afferents and central somatosensory pathways. It has revealed detailed insights into mechanisms of neuropathy, yet it remains unclear if pain directly affects sensory profiles. The main objective of this study was to investigate sensory profiles in patients with various neuropathic conditions, including polyneuropathy, mononeuropathy, and lesions to the central nervous system, in relation to self-reported presence or absence of pain and pain sensitivity using the Pain Sensitivity Questionnaire. A total of 443 patients (332 painful and 111 painless) and 112 healthy participants were investigated. Overall, loss of sensation was equally prevalent in patients with and without spontaneous pain. Pain thresholds were equally lowered in both patient groups, demonstrating that hyperalgesia and allodynia are just as present in patients not reporting any pain. Remarkably, this was similar for dynamic mechanical allodynia. Hypoalgesia was more pronounced in painful polyneuropathy, whereas hyperalgesia was more frequent in painful mononeuropathy (compared with painless conditions). Self-reported pain sensitivity was significantly higher in painful than in painless neuropathic conditions. Our results reveal the presence of hyperalgesia and allodynia in patients with central and peripheral lesions of the somatosensory system not reporting spontaneous pain. This shows that symptoms and signs of hypersensitivity may not necessarily coincide and that painful and painless neuropathic conditions may mechanistically blend into one another.",

author = "Julia Forstenpointner and Ruth Ruscheweyh and Nadine Attal and Ralf Baron and Didier Bouhassira and Enax-Krumova, {Elena K.} and Finnerup, {Nanna B.} and Rainer Freynhagen and Janne Gierthm{\"u}hlen and Per Hansson and Jensen, {Troels S.} and Christoph Maier and Rice, {Andrew S.C.} and M{\"a}rta Segerdahl and Thomas T{\"o}lle and Treede, {Rolf Detlef} and Jan Vollert",

note = "Publisher Copyright: Copyright {\textcopyright} 2020 International Association for the Study of Pain.",

year = "2021",

month = mar,

doi = "10.1097/j.pain.0000000000002058",

language = "English",

volume = "162",

pages = "718--727",

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Forstenpointner, J, Ruscheweyh, R, Attal, N, Baron, R, Bouhassira, D, Enax-Krumova, EK, Finnerup, NB, Freynhagen, R, Gierthmühlen, J, Hansson, P, Jensen, TS, Maier, C, Rice, ASC, Segerdahl, M, Tölle, T, Treede, RD & Vollert, J 2021, 'No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy', Pain, vol. 162, no. 3, pp. 718-727. https://doi.org/10.1097/j.pain.0000000000002058

No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy. / Forstenpointner, Julia; Ruscheweyh, Ruth; Attal, Nadine et al.
In: Pain, Vol. 162, No. 3, 03.2021, p. 718-727.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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T1 - No pain, still gain (of function)

T2 - the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy

AU - Forstenpointner, Julia

AU - Ruscheweyh, Ruth

AU - Attal, Nadine

AU - Baron, Ralf

AU - Bouhassira, Didier

AU - Enax-Krumova, Elena K.

AU - Finnerup, Nanna B.

AU - Freynhagen, Rainer

AU - Gierthmühlen, Janne

AU - Hansson, Per

AU - Jensen, Troels S.

AU - Maier, Christoph

AU - Rice, Andrew S.C.

AU - Segerdahl, Märta

AU - Tölle, Thomas

AU - Treede, Rolf Detlef

AU - Vollert, Jan

PY - 2021/3

Y1 - 2021/3

N2 - ABSTRACT: The pathophysiology of pain in neuropathy is complex and may be linked to sensory phenotypes. Quantitative sensory testing, a standardized method to evaluate sensory profiles in response to defined stimuli, assesses functional integrity of small and large nerve fiber afferents and central somatosensory pathways. It has revealed detailed insights into mechanisms of neuropathy, yet it remains unclear if pain directly affects sensory profiles. The main objective of this study was to investigate sensory profiles in patients with various neuropathic conditions, including polyneuropathy, mononeuropathy, and lesions to the central nervous system, in relation to self-reported presence or absence of pain and pain sensitivity using the Pain Sensitivity Questionnaire. A total of 443 patients (332 painful and 111 painless) and 112 healthy participants were investigated. Overall, loss of sensation was equally prevalent in patients with and without spontaneous pain. Pain thresholds were equally lowered in both patient groups, demonstrating that hyperalgesia and allodynia are just as present in patients not reporting any pain. Remarkably, this was similar for dynamic mechanical allodynia. Hypoalgesia was more pronounced in painful polyneuropathy, whereas hyperalgesia was more frequent in painful mononeuropathy (compared with painless conditions). Self-reported pain sensitivity was significantly higher in painful than in painless neuropathic conditions. Our results reveal the presence of hyperalgesia and allodynia in patients with central and peripheral lesions of the somatosensory system not reporting spontaneous pain. This shows that symptoms and signs of hypersensitivity may not necessarily coincide and that painful and painless neuropathic conditions may mechanistically blend into one another.

AB - ABSTRACT: The pathophysiology of pain in neuropathy is complex and may be linked to sensory phenotypes. Quantitative sensory testing, a standardized method to evaluate sensory profiles in response to defined stimuli, assesses functional integrity of small and large nerve fiber afferents and central somatosensory pathways. It has revealed detailed insights into mechanisms of neuropathy, yet it remains unclear if pain directly affects sensory profiles. The main objective of this study was to investigate sensory profiles in patients with various neuropathic conditions, including polyneuropathy, mononeuropathy, and lesions to the central nervous system, in relation to self-reported presence or absence of pain and pain sensitivity using the Pain Sensitivity Questionnaire. A total of 443 patients (332 painful and 111 painless) and 112 healthy participants were investigated. Overall, loss of sensation was equally prevalent in patients with and without spontaneous pain. Pain thresholds were equally lowered in both patient groups, demonstrating that hyperalgesia and allodynia are just as present in patients not reporting any pain. Remarkably, this was similar for dynamic mechanical allodynia. Hypoalgesia was more pronounced in painful polyneuropathy, whereas hyperalgesia was more frequent in painful mononeuropathy (compared with painless conditions). Self-reported pain sensitivity was significantly higher in painful than in painless neuropathic conditions. Our results reveal the presence of hyperalgesia and allodynia in patients with central and peripheral lesions of the somatosensory system not reporting spontaneous pain. This shows that symptoms and signs of hypersensitivity may not necessarily coincide and that painful and painless neuropathic conditions may mechanistically blend into one another.

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DO - 10.1097/j.pain.0000000000002058

M3 - Journal article

C2 - 32868752

AN - SCOPUS:85102153523

SN - 0304-3959

VL - 162

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JO - Pain

JF - Pain

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ER -

No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter cohort of patients with neuropathy

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