Referred pain and cutaneous responses from deep tissue electrical pain stimulation in the groin

E K Aasvang; M U Werner; H Kehlet

doi:10.1093/bja/aev170

Referred pain and cutaneous responses from deep tissue electrical pain stimulation in the groin

E K Aasvang, M U Werner, H Kehlet

Institut for Klinisk Medicin

3 Citationer (Scopus)

Abstract

BACKGROUND: Persistent postherniotomy pain is located around the scar and external inguinal ring and is often described as deep rather than cutaneous, with frequent complaints of pain in adjacent areas. Whether this pain is due to local pathology or referred/projected pain is unknown, hindering mechanism-based treatment.

METHODS: Deep tissue electrical pain stimulation by needle electrodes in the right groin (rectus muscle, ilioinguinal/iliohypogastric nerve and perispermatic cord) was combined with assessment of referred/projected pain and the cutaneous heat pain threshold (HPT) at three prespecified areas (both groins and the lower right arm) in 19 healthy subjects. The assessment was repeated 10 days later to assess the reproducibility of individual responses.

RESULTS: Deep electrical stimulation elicited pain at the stimulation site in all subjects, and in 15 subjects, pain from areas outside the stimulation area was reported, with 90-100% having the same response on both days, depending on the location. Deep pain stimulation significantly increased the cutaneous HPT (P<0.014). Individual HPT responses before and during deep electrical pain stimulation were significantly correlated (ρ>0.474, P≤0.040) at the two test days for the majority of test areas.

CONCLUSION: Our results corroborate a systematic relationship between deep pain and changes in cutaneous nociception. The individual referred/projected pain patterns and cutaneous responses are variable, but reproducible, supporting individual differences in anatomy and sensory processing. Future studies investigating the responses to deep tissue electrical stimulation in persistent postherniotomy pain patients may advance our understanding of underlying pathophysiological mechanisms and strategies for treatment and prevention.

TRIAL REGISTRY NUMBERS: ClinicalTrials.gov (NCT01701427).

Originalsprog	Engelsk
Tidsskrift	British Journal of Anaesthesia
Vol/bind	115
Udgave nummer	2
Sider (fra-til)	294-301
Antal sider	8
ISSN	0007-0912
DOI	https://doi.org/10.1093/bja/aev170
Status	Udgivet - 1 aug. 2015

Adgang til dokumentet

10.1093/bja/aev170

http://bjanaesthesia.org/article/S0007091217312035/pdf

Citationsformater

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title = "Referred pain and cutaneous responses from deep tissue electrical pain stimulation in the groin",

abstract = "BACKGROUND: Persistent postherniotomy pain is located around the scar and external inguinal ring and is often described as deep rather than cutaneous, with frequent complaints of pain in adjacent areas. Whether this pain is due to local pathology or referred/projected pain is unknown, hindering mechanism-based treatment.METHODS: Deep tissue electrical pain stimulation by needle electrodes in the right groin (rectus muscle, ilioinguinal/iliohypogastric nerve and perispermatic cord) was combined with assessment of referred/projected pain and the cutaneous heat pain threshold (HPT) at three prespecified areas (both groins and the lower right arm) in 19 healthy subjects. The assessment was repeated 10 days later to assess the reproducibility of individual responses.RESULTS: Deep electrical stimulation elicited pain at the stimulation site in all subjects, and in 15 subjects, pain from areas outside the stimulation area was reported, with 90-100% having the same response on both days, depending on the location. Deep pain stimulation significantly increased the cutaneous HPT (P<0.014). Individual HPT responses before and during deep electrical pain stimulation were significantly correlated (ρ>0.474, P≤0.040) at the two test days for the majority of test areas.CONCLUSION: Our results corroborate a systematic relationship between deep pain and changes in cutaneous nociception. The individual referred/projected pain patterns and cutaneous responses are variable, but reproducible, supporting individual differences in anatomy and sensory processing. Future studies investigating the responses to deep tissue electrical stimulation in persistent postherniotomy pain patients may advance our understanding of underlying pathophysiological mechanisms and strategies for treatment and prevention.TRIAL REGISTRY NUMBERS: ClinicalTrials.gov (NCT01701427).",

keywords = "Adult, Electric Stimulation, Groin, Humans, Pain Threshold, Pain, Referred, Reproducibility of Results",

author = "Aasvang, {E K} and Werner, {M U} and H Kehlet",

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T1 - Referred pain and cutaneous responses from deep tissue electrical pain stimulation in the groin

AU - Aasvang, E K

AU - Werner, M U

AU - Kehlet, H

PY - 2015/8/1

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N2 - BACKGROUND: Persistent postherniotomy pain is located around the scar and external inguinal ring and is often described as deep rather than cutaneous, with frequent complaints of pain in adjacent areas. Whether this pain is due to local pathology or referred/projected pain is unknown, hindering mechanism-based treatment.METHODS: Deep tissue electrical pain stimulation by needle electrodes in the right groin (rectus muscle, ilioinguinal/iliohypogastric nerve and perispermatic cord) was combined with assessment of referred/projected pain and the cutaneous heat pain threshold (HPT) at three prespecified areas (both groins and the lower right arm) in 19 healthy subjects. The assessment was repeated 10 days later to assess the reproducibility of individual responses.RESULTS: Deep electrical stimulation elicited pain at the stimulation site in all subjects, and in 15 subjects, pain from areas outside the stimulation area was reported, with 90-100% having the same response on both days, depending on the location. Deep pain stimulation significantly increased the cutaneous HPT (P<0.014). Individual HPT responses before and during deep electrical pain stimulation were significantly correlated (ρ>0.474, P≤0.040) at the two test days for the majority of test areas.CONCLUSION: Our results corroborate a systematic relationship between deep pain and changes in cutaneous nociception. The individual referred/projected pain patterns and cutaneous responses are variable, but reproducible, supporting individual differences in anatomy and sensory processing. Future studies investigating the responses to deep tissue electrical stimulation in persistent postherniotomy pain patients may advance our understanding of underlying pathophysiological mechanisms and strategies for treatment and prevention.TRIAL REGISTRY NUMBERS: ClinicalTrials.gov (NCT01701427).

AB - BACKGROUND: Persistent postherniotomy pain is located around the scar and external inguinal ring and is often described as deep rather than cutaneous, with frequent complaints of pain in adjacent areas. Whether this pain is due to local pathology or referred/projected pain is unknown, hindering mechanism-based treatment.METHODS: Deep tissue electrical pain stimulation by needle electrodes in the right groin (rectus muscle, ilioinguinal/iliohypogastric nerve and perispermatic cord) was combined with assessment of referred/projected pain and the cutaneous heat pain threshold (HPT) at three prespecified areas (both groins and the lower right arm) in 19 healthy subjects. The assessment was repeated 10 days later to assess the reproducibility of individual responses.RESULTS: Deep electrical stimulation elicited pain at the stimulation site in all subjects, and in 15 subjects, pain from areas outside the stimulation area was reported, with 90-100% having the same response on both days, depending on the location. Deep pain stimulation significantly increased the cutaneous HPT (P<0.014). Individual HPT responses before and during deep electrical pain stimulation were significantly correlated (ρ>0.474, P≤0.040) at the two test days for the majority of test areas.CONCLUSION: Our results corroborate a systematic relationship between deep pain and changes in cutaneous nociception. The individual referred/projected pain patterns and cutaneous responses are variable, but reproducible, supporting individual differences in anatomy and sensory processing. Future studies investigating the responses to deep tissue electrical stimulation in persistent postherniotomy pain patients may advance our understanding of underlying pathophysiological mechanisms and strategies for treatment and prevention.TRIAL REGISTRY NUMBERS: ClinicalTrials.gov (NCT01701427).

KW - Adult

KW - Electric Stimulation

KW - Groin

KW - Humans

KW - Pain Threshold

KW - Pain, Referred

KW - Reproducibility of Results

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DO - 10.1093/bja/aev170

M3 - Journal article

C2 - 26071091

SN - 0007-0912

VL - 115

SP - 294

EP - 301

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 2

ER -

Referred pain and cutaneous responses from deep tissue electrical pain stimulation in the groin

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