Generalized expansion of nociceptive reflex receptive fields in chronic pain patients

Neziri, Alban Y; Haesler, S; Petersen-Felix, Steen; Müller, Michael; Arendt-Nielsen, Lars; Manresa, Jose Biurrun; Andersen, Ole K; Curatolo, Michele (2010). Generalized expansion of nociceptive reflex receptive fields in chronic pain patients. Pain, 151(3), pp. 798-805. Amsterdam: Elsevier 10.1016/j.pain.2010.09.017

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Widespread central hypersensitivity is present in chronic pain and contributes to pain and disability. According to animal studies, expansion of receptive fields of spinal cord neurons is involved in central hypersensitivity. We recently developed a method to quantify nociceptive receptive fields in humans using spinal withdrawal reflexes. Here we hypothesized that patients with chronic pelvic pain display enlarged reflex receptive fields. Secondary endpoints were subjective pain thresholds and nociceptive withdrawal reflex thresholds after single and repeated (temporal summation) electrical stimulation. 20 patients and 25 pain-free subjects were tested. Electrical stimuli were applied to 10 sites on the foot sole for evoking reflexes in the tibialis anterior muscle. The reflex receptive field was defined as the area of the foot (fraction of the foot sole) from which a muscle contraction was evoked. For the secondary endpoints, the stimuli were applied to the cutaneous innervation area of the sural nerve. Medians (25-75 percentiles) of fraction of the foot sole in patients and controls were 0.48 (0.38-0.54) and 0.33 (0.27-0.39), respectively (P=0.008). Pain and reflex thresholds after sural nerve stimulation were significantly lower in patients than in controls (P<0.001 for all measurements). This study provides for the first time evidence for widespread expansion of reflex receptive fields in chronic pain patients. It thereby identifies a mechanism involved in central hypersensitivity in human chronic pain. Reverting the expansion of nociceptive receptive fields and exploring the prognostic meaning of this phenomenon may become future targets of clinical research.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
UniBE Contributor:	Neziri, Alban Y.
ISSN:	0304-3959
Publisher:	Elsevier
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	04 Oct 2013 14:08
Last Modified:	05 Dec 2022 14:00
Publisher DOI:	10.1016/j.pain.2010.09.017
PubMed ID:	20926191
Web of Science ID:	000283657300034
URI:	https://boris.unibe.ch/id/eprint/534 (FactScience: 199706)