Touch-evoked Neuropathic Pain in Clinical Practice: A Case Series of 1000 Paradoxical Painful Hypo-aesthesia.

Guest editorial
Écrit par Spicher Méloé

[Citation] : Spicher, C.J. (2016). Editorial : Touch-evoked Neuropathic Pain in Clinical Practice: A Case Series of 1000 Paradoxical Painful Hypo-aesthesia. e-News Somatosens Rehab, 13(2), 52-57.

Claude J SPICHER[1]

“In the present study, 100 % of the Static Mechancial Allodynia (SMA) territories (n=63) investigated and treated on the skin of 43 patients completely disappeared, replaced by an underlying hypoaesthetic territory, which was then treated at a later stage. This clinically highly significant result was obtained using the Distant Vibrotactile Counter-Stimulation (DVCS) treatment: weekly in therapy and daily at home by application of tactile stimuli eight times a day for 1 minute.” (Spicher et al., 2008a). We concluded that SMA is a paradoxical painful to touch hypo-aesthesia.

Since the 1st of July 2004, these data were collected and recorded by somatosensory therapists of pain at the Somatosensory Rehabilitation Centre (Fribourg, Switzerland).

The 27h of May 2016, we observed for the 1000th times the same phenomenon (Table I):

  • When the hyper-sensitivity to touch – allodynia – disappears, an underlying tactile hypo-aesthesia is revealed.

 

In other words, the Certified Somatosensory Therapists of Pain (CSTP®) would say: “When the allodynography becomes negative, it is the moment to map a positive secondary aesthesiography. None of the SMA territory – represented by the allodynography - becomes immediately normosensitive at the end of the DVCS treatment”.

Table I: The 1000 tactile allodynia territories investigated and treated with DVCS, switched into 1000 tactile hypoaesthetic territories, referred to as underlying hypoaesthesia

Basic knowledge

Treatment of Touch-evoked Neuropathic Pain:

1)       To postulate which branch of the cutaneous nerve affected is damaged.

2)       To define a specific zone of the skin where DVCS should be applied eight times a day for 1 minute - or less long - at home.

3)       To delineate a specific zone of the skin to be avoided as much as possible: STOP sensitization by temporarily NOT TOUCHING, if possible the painful territory.

In the present case series, 714 neuropathic pain patients who presented in total 1000 static mechanical allodynia completed their DVCS treatment (Table II).

Table II: The somatosensory and/or neuropathic conditions of 714 patients with 1000 SMA territories.

This phenomenon can be consistently observed in each cutaneous distribution territory of the 240 cutaneous branches of the human body (Spicher et al., 2013) in 10 cutaneous departments (Table III).

Table III : Distribution of 1000 underlying tactile hypoaesthetic territories of the 10 cutaneous departments of the human body.

We conclude that one of the aetiologies of tactile allodynia is Aβ neurofibers lesion of a cutaneous branch.

Part of these results have been already published (Clément-Favre, 2011 ; Della Casa et al., 2010 ; Desfoux et al., 2008 ; Desfoux, et al., 2009 ; Grass et al., 2008 ; Mathis et al., 2006 ; Mathis et al., 2007 ;  Spicher et al., 2008a, 2008b, 2015, 2016) and will be published in the further years. Numerous Case Reports have been as well published with the same observation in Belgium (Behar, 2013), in Switzerland (Duchesne, 2014), in France (Landreau, 2010; Langlois, 2014 ; Parneix, 2015) and in Canada (Calva, 2013 ; Packham, 2013).

 

References

[1] Unit of Neurophysiology, Department of Medicine, Faculty of Science, University of Fribourg & Somatosensory Rehabilitation Centre ; Clinique Générale; 6, Hans-Geiler Street  ; CH - 1700 Fribourg Switzerland ; reeducation.sensitive@cliniquegenerale.ch

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