Objectives: Widespread sensory deficits occur in 20-40% of chronic pain patients on the side of pain, independent of pain aetiology, and are known as nondermatomal sensory deficits (NDSDs). NDSDs can occur in absence of central or peripheral nervous system lesions. We hypothesised that NDSDs were associated with cerebral grey matter changes in the sensory system and in pain processing regions, detectable with voxel-based morphometry.
Methods: Twenty-five patients with NDSDs, 23 patients without NDSDs ("pain-only"), and 29 healthy controls were studied with high resolution structural MRI of the brain. A comprehensive clinical and psychiatric evaluation based on Diagnostic and Statistical Manual was performed in all patients.
Results: Patients with NDSDs and "pain-only" did not differ concerning demographic data and psychiatric diagnoses, although anxiety scores (HADS-A) were higher in patients with NDSDs. In patients with NDSDs, grey matter increases were found in the right primary sensory cortex, thalamus, and bilaterally in lateral temporal regions and the hippocampus/fusiform gyrus. "Pain-only" patients showed a bilateral grey matter increase in the posterior insula and less pronounced changes in sensorimotor cortex.
Conclusions: Dysfunctional sensory processing in patients with NDSDs is associated with complex changes in grey matter volume, involving the somatosensory system and temporal regions.
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Bilateral Sensory Changes and High Burden of Disease in Patients With Chronic Pain and Unilateral Nondermatomal Somatosensory Deficits: A Quantitative Sensory Testing and Clinical Study.
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August 2017
*Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil †Department of General Internal Medicine, Psychosomatic Division, C.L. Lory-Haus, Inselspital, University Hospital, Bern ‡RehaClinic, Bad Zurzach ¶Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich Departments of §Psychiatry **Neurology, University Hospital Zurich #Medical Practice Hottingen, Zurich ∥ANNR Neurology, RehaClinic, Baden, Switzerland ††Neurological Center Rosenhuegel & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.
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Nondermatomal somatosensory deficits in chronic pain are associated with cerebral grey matter changes.
World J Biol Psychiatry
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f RehaClinic , Bad Zurzach/Baden , Switzerland.
Objectives: Widespread sensory deficits occur in 20-40% of chronic pain patients on the side of pain, independent of pain aetiology, and are known as nondermatomal sensory deficits (NDSDs). NDSDs can occur in absence of central or peripheral nervous system lesions. We hypothesised that NDSDs were associated with cerebral grey matter changes in the sensory system and in pain processing regions, detectable with voxel-based morphometry.
View Article and Find Full Text PDFNondermatomal somatosensory deficits in chronic pain patients: are they really hysterical?
Pain
September 2012
Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern CH-3010, Switzerland Division of Psychosomatic and Psychotherapeutic Medicine, Lindenhofspital Bern, Bern CH-3012, Switzerland.
Patients with chronic pain disorders frequently show nondermatomal somatosensory deficits (NDSDs) that are considered to be functional. Typically, NDSDs show quadratomal or hemibody distribution ipsilateral to the areas of chronic pain. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition and the International Classification of Diseases, 10th revision, such functional somatosensory deficits are classified in the chapter "conversion disorder.
View Article and Find Full Text PDF[Nondermatomal somatosensory deficits in chronic pain patients].
Schmerz
December 2011
Kompetenzbereich für Psychosomatische Medizin, Universitätsklinik für Allgemeine Innere Medizin, C.L. Lory-Haus, Inselspital Bern, 3010, Bern, Schweiz.
Nondermatomal somatosensory deficits (NDSDs) are frequently found in chronic pain patients and allude to pain sensitization and pain centralization. In the clinical examination NDSDs are as a rule accompanied by hyposensitivity to touch and heat perception often with a quadrantal or hemibody distribution. The majority of NDSD patients show a trigger episode with a somatic nociceptive trauma in the case history.
View Article and Find Full Text PDFOn the nature of nondermatomal somatosensory deficits.
Clin J Pain
January 2011
Comprehensive Pain Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada.
Objectives: Nondermatomal somatosensory deficits (NDSDs) not conforming to the distribution of peripheral nerves or dermatomes, and often present after a minor injury or with no known inciting event, have long been associated with "hysteria." This article reviews the modern literature concerning NDSDs associated with chronic pain with regard to their prevalence, phenomenology and clinical presentation, clinical assessment, etiology and pathophysiology, relationship with Conversion Disorder and psychological factors, and their treatment and prognosis.
Methods: Past research and relevant literature concerning NDSDs are reviewed and summarized.
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