TY - JOUR
T1 - Paradoxical heat sensation as a manifestation of thermal hypesthesia
T2 - a study of 1090 patients with lesions of the somatosensory system
AU - Vollert, Jan
AU - Fardo, Francesca
AU - Attal, Nadine
AU - Baron, Ralf
AU - Bouhassira, Didier
AU - Enax-Krumova, Elena K.
AU - Freynhagen, Rainer
AU - Hansson, Per
AU - Jensen, Troels S.
AU - Kersebaum, Dilara
AU - Maier, Christoph
AU - Pogatzki-Zahn, Esther
AU - Rice, Andrew S.C.
AU - Sachau, Juliane
AU - Schaldemose, Ellen L.
AU - Segerdahl, Märta
AU - Sendel, Manon
AU - Tölle, Thomas R.
AU - Finnerup, Nanna B.
AU - Treede, Rolf Detlef
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Paradoxical heat sensation (PHS) is the perception of warmth when the skin is cooled. Paradoxical heat sensation rarely occurs in healthy individuals but more frequently in patients suffering from lesions or disease of the peripheral or central nervous system. To further understand mechanisms and epidemiology of PHS, we evaluated the occurrence of PHS in relation to disease aetiology, pain levels, quantitative sensory testing parameters, and Neuropathic Pain Symptom Inventory (NPSI) items in patients with nervous system lesions. Data of 1090 patients, including NPSI scores from 404 patients, were included in the analysis. We tested 11 quantitative sensory testing parameters for thermal and mechanical detection and pain thresholds, and 10 NPSI items in a multivariate generalised linear model with PHS, aetiology, and pain (yes or no) as fixed effects. In total, 30% of the neuropathic patients reported PHS in contrast to 2% of healthy individuals. The frequency of PHS was not linked to the presence or intensity of pain. Paradoxical heat sensation was more frequent in patients living with polyneuropathy compared with central or unilateral peripheral nerve lesions. Patients who reported PHS demonstrated significantly lower sensitivity to thermal perception, with lower sensitivity to normally painful heat and cold stimuli. Neuropathic Pain Symptom Inventory scores were lower for burning and electric shock-like pain quality for patients with PHS. Our findings suggest that PHS is associated with loss of small thermosensory fibre function normally involved in cold and warm perception. Clinically, presence of PHS could help screening for loss of small fibre function as it is straightforward to measure or self-reported by patients.
AB - Paradoxical heat sensation (PHS) is the perception of warmth when the skin is cooled. Paradoxical heat sensation rarely occurs in healthy individuals but more frequently in patients suffering from lesions or disease of the peripheral or central nervous system. To further understand mechanisms and epidemiology of PHS, we evaluated the occurrence of PHS in relation to disease aetiology, pain levels, quantitative sensory testing parameters, and Neuropathic Pain Symptom Inventory (NPSI) items in patients with nervous system lesions. Data of 1090 patients, including NPSI scores from 404 patients, were included in the analysis. We tested 11 quantitative sensory testing parameters for thermal and mechanical detection and pain thresholds, and 10 NPSI items in a multivariate generalised linear model with PHS, aetiology, and pain (yes or no) as fixed effects. In total, 30% of the neuropathic patients reported PHS in contrast to 2% of healthy individuals. The frequency of PHS was not linked to the presence or intensity of pain. Paradoxical heat sensation was more frequent in patients living with polyneuropathy compared with central or unilateral peripheral nerve lesions. Patients who reported PHS demonstrated significantly lower sensitivity to thermal perception, with lower sensitivity to normally painful heat and cold stimuli. Neuropathic Pain Symptom Inventory scores were lower for burning and electric shock-like pain quality for patients with PHS. Our findings suggest that PHS is associated with loss of small thermosensory fibre function normally involved in cold and warm perception. Clinically, presence of PHS could help screening for loss of small fibre function as it is straightforward to measure or self-reported by patients.
KW - Neuropathic Pain Symptom Inventory
KW - Neuropathic pain
KW - Neuropathy
KW - Paradoxical heat sensation
KW - Quantitative sensory testing
UR - http://www.scopus.com/inward/record.url?scp=85179848173&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000003014
DO - 10.1097/j.pain.0000000000003014
M3 - Article
C2 - 37578447
AN - SCOPUS:85179848173
SN - 0304-3959
VL - 165
SP - 216
EP - 224
JO - Pain
JF - Pain
IS - 1
ER -