PDF(Pubmed)
Abstract：
UNASSIGNED: Notalgia paresthetica (NP) is a chronic condition characterized by pruritus and other unpleasant dysesthetic sensations unilaterally on the subscapular back. Its specific underlying mechanisms are largely unknown, though hypothesized to be neuropathic. Determination of possible somatosensory contributors to the condition could pave the way for novel treatments.
UNASSIGNED: Given the potential involvement of non-pruritic mechanisms in NP, our objective was to broadly characterize the somatosensory function in NP-affected and unaffected skin using methods that have been standardized in pain-free controls and painful neuropathic disorders. We hypothesized that if NP is caused by neuropathic mechanisms not targeted directly to pruritoceptors in the skin, somatosensory abnormalities would not be itchspecific. Second, given the lack of symptoms on the contralateral side of the back, we hypothesized that this region would be normally sensitive.
UNASSIGNED: In this study, quantitative sensory testing (QST) was used to comprehensively assess the somatosensory function in 15 adult patients with NP. Standardized QST metrics were performed in the NP-affected region and compared with the contralateral asymptomatic skin and itch-free individuals using an age, gender, and site-matched reference data set.
UNASSIGNED: There were no significant differences in sensitivity between symptomatic and asymptomatic skin, except for increased mechanical-evoked itch on the itchy side. However, reference data set comparisons revealed bilateral hyposensitivity to innocuous cold and noxious pinprick and higher temporal summation of pain in patients with NP. In addition, compared with reference data, patients with NP demonstrated decreased sensitivity to cold and pinprick, presence of paradoxical heat sensations, and increased wind-up of pain.
UNASSIGNED: These results suggest a role for Aδ fiber pathways and central sensitization in NP-associated itch. More research is needed to determine whether sensory differences extend beyond the NP-affected dermatomal level and what might cause neuropathy specifically targeting Aδ fibers.
UNASSIGNED: Given the potential involvement of non-pruritic mechanisms in NP, our objective was to broadly characterize the somatosensory function in NP-affected and unaffected skin using methods that have been standardized in pain-free controls and painful neuropathic disorders. We hypothesized that if NP is caused by neuropathic mechanisms not targeted directly to pruritoceptors in the skin, somatosensory abnormalities would not be itchspecific. Second, given the lack of symptoms on the contralateral side of the back, we hypothesized that this region would be normally sensitive.
UNASSIGNED: In this study, quantitative sensory testing (QST) was used to comprehensively assess the somatosensory function in 15 adult patients with NP. Standardized QST metrics were performed in the NP-affected region and compared with the contralateral asymptomatic skin and itch-free individuals using an age, gender, and site-matched reference data set.
UNASSIGNED: There were no significant differences in sensitivity between symptomatic and asymptomatic skin, except for increased mechanical-evoked itch on the itchy side. However, reference data set comparisons revealed bilateral hyposensitivity to innocuous cold and noxious pinprick and higher temporal summation of pain in patients with NP. In addition, compared with reference data, patients with NP demonstrated decreased sensitivity to cold and pinprick, presence of paradoxical heat sensations, and increased wind-up of pain.
UNASSIGNED: These results suggest a role for Aδ fiber pathways and central sensitization in NP-associated itch. More research is needed to determine whether sensory differences extend beyond the NP-affected dermatomal level and what might cause neuropathy specifically targeting Aδ fibers.
摘要：
■感觉异常疼痛（NP）是一种慢性疾病，其特征是在肩胛骨下背部单侧出现瘙痒和其他令人不快的感觉障碍。其具体的潜在机制在很大程度上是未知的，虽然假设是神经病。确定可能的体感因素可以为新的治疗方法铺平道路。
■考虑到非瘙痒机制在NP中的潜在参与，我们的目标是使用在无痛对照和疼痛性神经性疾病中标准化的方法,广泛表征NP感染和未受影响的皮肤的体感功能.我们假设，如果NP是由不直接针对皮肤瘙痒感受器的神经病理机制引起的，体感异常不会发痒。第二,鉴于背部对侧没有症状，我们假设这个地区通常是敏感的。
■在这项研究中，定量感觉测试（QST）用于综合评估15例成年NP患者的体感功能。在NP受影响的区域进行标准化的QST指标，并使用年龄与对侧无症状皮肤和无痒个体进行比较，性别,和站点匹配的参考数据集。
■有症状和无症状的皮肤之间的敏感性没有显着差异，除了瘙痒一侧的机械诱发瘙痒增加。然而,参考数据集比较显示，NP患者对无害感冒和有害针刺的双侧敏感性低，疼痛的时间总和更高。此外,与参考数据相比，NP患者对寒冷和针刺的敏感性降低，存在矛盾的热感觉，增加了疼痛的结束。
■这些结果表明Aδ纤维途径和中枢敏化在NP相关瘙痒中起作用。需要更多的研究来确定感觉差异是否超出了受NP影响的皮肤瘤水平，以及什么可能导致特定靶向Aδ纤维的神经病变。
■考虑到非瘙痒机制在NP中的潜在参与，我们的目标是使用在无痛对照和疼痛性神经性疾病中标准化的方法,广泛表征NP感染和未受影响的皮肤的体感功能.我们假设，如果NP是由不直接针对皮肤瘙痒感受器的神经病理机制引起的，体感异常不会发痒。第二,鉴于背部对侧没有症状，我们假设这个地区通常是敏感的。
■在这项研究中，定量感觉测试（QST）用于综合评估15例成年NP患者的体感功能。在NP受影响的区域进行标准化的QST指标，并使用年龄与对侧无症状皮肤和无痒个体进行比较，性别,和站点匹配的参考数据集。
■有症状和无症状的皮肤之间的敏感性没有显着差异，除了瘙痒一侧的机械诱发瘙痒增加。然而,参考数据集比较显示，NP患者对无害感冒和有害针刺的双侧敏感性低，疼痛的时间总和更高。此外,与参考数据相比，NP患者对寒冷和针刺的敏感性降低，存在矛盾的热感觉，增加了疼痛的结束。
■这些结果表明Aδ纤维途径和中枢敏化在NP相关瘙痒中起作用。需要更多的研究来确定感觉差异是否超出了受NP影响的皮肤瘤水平，以及什么可能导致特定靶向Aδ纤维的神经病变。
