Abstract
Study design:
Controlled, cross-sectional, observational.
Objectives:
To investigate whether quantitative sensory testing (QST) is able to reveal subclinical deficits at the neurological level of lesion in subjects with chronic spinal cord injury (SCI).
Setting:
National Spinal Injuries Centre, Stoke Mandeville Hospital and Imperial College London, UK.
Methods:
QST and clinical assessments were carried out on 18 subjects with complete SCI (American Spinal Injury Association (ASIA) grade A) and 10 subjects with incomplete SCI (ASIA grades B, C or D). A total of 10 healthy subjects acted as controls.
Results:
At the level of lesion perceptual thresholds to monofilaments, cold pain and heat pain were similar to values in control subjects but cool and warm thresholds were significantly raised. A correlation between cool and warm thresholds was observed at the level of lesion in complete SCI and between heat and cold pain thresholds at the level of lesion in complete SCI, incomplete SCI and in control subjects. In the zone of partial preservation in complete SCI and below the level of lesion in incomplete SCI, thresholds for all modalities were all different compared to controls.
Conclusion:
QST reveals impaired thermal sensation in dermatomes clinically defined as normal with ASIA standards. Quantitative thermal testing therefore permits a discriminating assessment of preserved sensation and subclinical deficit and has the potential to improve upon the clinical detection of natural recovery or changes in level of injury following interventions designed to repair SCI.
Sponsorship:
The International Spinal Research Trust.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Finnerup NB, Johannesen IL, Bach FW, Jensen TS . Sensory function above lesion level in spinal cord injury patients with and without pain. Somatosensory Mot Res 2003a; 20: 71–76.
Melzack R, Loeser JD . Phantom body pain in paraplegics: evidence for a central ‘pattern generating mechanism’ for pain. Pain 1978; 4: 195–210.
Lenz FA et al. Abnormal single-unit activity recorded in the somatosensory thalamus of a quadriplegic patient with central pain. Pain 1987; 31: 225–236.
Lenz FA, Kwan HC, Martin R, Tasker R, Richardson RT, Dostrovsky JO . Characteristics of somatotopic organization and spontaneous neuronal activity in the region of the thalamic principal sensory nucleus in patients with spinal cord transection. J Neurophysiol 1994; 72: 1570–1587.
Moore CI, Stern CE, Dunbar C, Kostyk SK, Gehi A, Corkin S . Referred phantom sensations and cortical reorganization after spinal cord injury in humans. Proc Natl Acad Sci USA 2000; 97: 14703–14708.
Finnerup NB, Johanneson IL, Fuglsang-Frederiksen A, Bach FW, Jensen TS . Sensory function in spinal cord injury patients with and without central pain. Brain 2003b; 126: 57–70.
Shy ME et al. Quantitative sensory testing. Report of the therapeutics and technology assessment subcommittee of the american academy of neurology. Neurology 2003; 60: 898–904.
Price DD, Long S, Huitt C . Sensory testing of pathophysiological mechanisms of pain in patients with reflex sympathetic dystrophy. Pain 1992; 49: 163–173.
Meier PM, Berde CB, DiCanzio J, Zurakowski D, Sethna NF . Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection in healthy children and adolescents. Muscle Nerve 2001; 24: 1339–1345.
Anand P, Birch R . Restoration of sensory function and lack of long-term chronic pain syndromes after brachial plexus injury in human neonates. Brain 2002; 125: 113–122.
Suarez GA, Dyck PJ . Quantitative sensory assessment. In: Dyck PJ, Thomas PK (eds). Diabetic Neuropathy 2nd edn. WB Saunders: Philadelphia 1999 Chapter 10.
Verdugo R, Ochoa JL . Quantitative somatosensory thermotest. A key method for functional evaluation of small calibre afferent channels. Brain 1992; 115: 893–913.
Yarnitsky D, Kunin M, Brik R, Sprecher E . Vibration reduces pain in adjacent dermatomes. Pain 1997; 69: 75–77.
Quraishi NA, Taherzadeh O, McGregor AH, Hughes SP, Anand P . Correlation of nerve root pain with dermatomal sensory threshold and back pain with spinal movement in single level lumbar spondylosis. J Bone Surg Br 2004; 86: 74–80.
Finnerup NB, Gyldensted C, Fuglsang-Frederiksen A, Bach FW, Jensen TS . Sensory perception in complete spinal cord injury. Acta Neurol Scand 2004; 109: 194–199.
Krassioukov A, Wolfe DL, Hsieh JT, Hayes KC, Durham CE . Quantitative sensory testing in patients with incomplete spinal cord injury. Arch Phys Med Rehabil 1999; 80: 1258–1263.
Maynard FM et al. International standards for neurological and functional classification of spinal cord Injury. American spinal injury association. Spinal Cord 1997; 35: 266–274.
Ellaway PH et al. Towards improved clinical and physiological assessments of recovery in spinal cord injury: a clinical initiative. Spinal Cord 2004; 42: 325–337.
Defrin R, Ohry A, Blumen A, Urca G . Characterization of chronic pain and somatosensory function in spinal cord injury subjects. Pain 2001; 89: 253–263.
Foerster O . The dermatomes in man. Brain 1933; 56: 1–39.
Tator CH . Update on the pathophysiology and pathology of acute spinal cord injury. Brain Pathol 1995; 5: 407–413.
Fawcett J . Repair of spinal cord injuries: where are we, where are we going? Spinal Cord 2002; 40: 615–623.
Lynn B, Perl ER . A comparison of four tests for assessing the pain sensitivity of different subjects and test areas. Pain 1977; 3: 353–365.
Janal MN, Glusman M, Kuhl JP, Clark WC . On the absence of correlation between responses to noxious heat, cold, electrical and ischemic stimulation. Pain 1994; 58: 403–411.
Light AR, Perl ER . Peripheral sensory systems. In: Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF (eds). Peripheral Neuropathy. Saunders: Philadelphia 1993.
Wolff BB, Jarvik ME . Relationship between superficial and deep somatic thresholds of pain with a note on handedness. Am J Psychol 1964; 77: 589–599.
Davidson PO, McDougall CEA . The generality of pain tolerance. J Psychosom Res 1969; 13: 83–89.
Hensel H . Functional and structional basis of thermoception. Prog Brain Res 1976; 43: 105–118.
Willis WD, Coggeshall RE . Sensory Mechanisms of the Spinal Cord. Plenum Press: New York 1978, pp 363–420.
Defrin R, Ohry A, Blumen N, Urca G . Sensory determinants of thermal pain. Brain 2002; 125: 501–510.
Eide PK, Jerum E, Stenehjem AE . Somatosensory findings in patients with spinal cord injury and central dysaesthesia pain. J Neurol Neurosurg Psychiatr 1966; 60: 411–415.
Acknowledgements
We thank all the subjects for their participation.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nicotra, A., Ellaway, P. Thermal perception thresholds: assessing the level of human spinal cord injury. Spinal Cord 44, 617–624 (2006). https://doi.org/10.1038/sj.sc.3101877
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.sc.3101877
Keywords
This article is cited by
-
Reliability of the electrical perceptual threshold and Semmes-Weinstein monofilament tests of cutaneous sensibility
Spinal Cord (2013)
-
Light touch and pin prick disparity in the International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI)
Spinal Cord (2013)
-
Biopsychosocial outcomes in individuals with and without spinal cord injury: a Swiss comparative study
Spinal Cord (2012)
-
Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury
Spinal Cord (2011)
-
A quantitative skin impedance test to diagnose spinal cord injury
European Spine Journal (2009)
