Mirror peripheral neuropathy and unilateral chronic neuropathic pain: insights from asymmetric neurological patterns in leprosy.
Irina RaicherAlexandra P ZandonaiIsadora W AnghinahMariana FrassettoPatrick R N A G StumpMaria A B TrindadeSimone HarnikRodrigo A OliveiraRicardo S S MacarencoKathrin DopplerNurcan ÜçeylerEvandro S MelloClaudia SommerManoel J TeixeiraRicardo GalhardoniDaniel C de AndradePublished in: Pain (2022)
Leprosy-related multiple mononeuropathy offers a pattern of impairment where neuropathy with and without neuropathic pain (NeP) are present in the same individual, thus allowing to investigate peripheral sensory and innervation in both conditions. This cross-sectional study collected data on clinical and neurological examination, pain assessment questionnaires, quantitative sensory test, and intraepidermal nerve fiber density of patients with leprosy and divided the cohort into 2 groups: with NeP (P+) and without NeP (P-). Furthermore, we assessed mirror body areas in the same NeP individuals with bilateral neuropathy also presenting unilateral NeP. Pain-free patients having unilateral neuropathy were controls. A total of 37 P+ and 22 P- patients were evaluated. Limb areas with NeP had signs of C-fiber dysfunction and hyperesthesia on quantitative sensory testing compared with limb areas having neuropathy without NeP. Skin denervation was found in all patients with leprosy. Comparisons of limbs with and without neuropathy and with and without NeP revealed that higher heat pain thresholds (HPTs) were associated with neuropathic pain areas, whereas less altered HPT was correlated with higher fiber density. Furthermore, a relationship was found between time of leprosy treatment termination and more intense neuropathy, expressed by HPT increasing 0.03°C each month. As expected, interindividual comparisons failed to show differences in intraepidermal nerve fiber density and subepidermal plexus areas between P+ and P- patients ( P = 0.2980, P = 0.9044; respectively). Higher HPT and lower mechanical detection threshold were related to NeP. This study pointed out the relevance of intraindividual comparisons including mirror areas when assessing local changes in peripheral NeP.
Keyphrases
- neuropathic pain
- spinal cord
- end stage renal disease
- spinal cord injury
- newly diagnosed
- ejection fraction
- chronic kidney disease
- chronic pain
- prognostic factors
- peritoneal dialysis
- patient reported outcomes
- machine learning
- case report
- deep learning
- cerebral ischemia
- heat stress
- artificial intelligence
- single cell
- smoking cessation
- data analysis
- peripheral nerve
- combination therapy
- postoperative pain
- blood brain barrier
- psychometric properties
- solid state
- replacement therapy