Extraterritorial temperature pain threshold abnormalities in subjects with healed thermal injury.

Approximately 1.25 million individuals sustain burn injuries annually in the United States. Pain is frequent in patients with burn injuries and is often refractory to pharmacotherapy. We report quantitative sensory data from five subjects who sustained external thermal injuries to their limb(s) 8 weeks to 11 years previously, demonstrating reduced thermal pain thresholds in regions outside the burn injury zone, including contralateral limbs. Warm and cold detection thresholds were not significantly different from controls. These results complement data from animal models that demonstrate that allodynia can develop contralateral to a focal burn injury as a result of changes within the spinal cord and suggest that systemic or central mechanisms contribute to pain after burn injury.

[1]  S. Waxman,et al.  Minocycline attenuates mechanical allodynia and central sensitization following peripheral second-degree burn injury. , 2010, The journal of pain : official journal of the American Pain Society.

[2]  S. Waxman,et al.  Unilateral focal burn injury is followed by long-lasting bilateral allodynia and neuronal hyperexcitability in spinal cord dorsal horn. , 2010, The journal of pain : official journal of the American Pain Society.

[3]  L. Sorkin,et al.  Spinal p38 mitogen‐activated protein kinase mediates allodynia induced by first‐degree burn in the rat , 2009, Journal of neuroscience research.

[4]  J. Levine,et al.  Proinflammatory cytokines mediating burn-injury pain , 2008, PAIN®.

[5]  M. Ubré,et al.  Contralateral Neuropathic Pain Following a Surgical Model of Unilateral Nerve Injury in Rats , 2007, Regional Anesthesia & Pain Medicine.

[6]  J. Levine,et al.  Enhanced inflammatory hyperalgesia after recovery from burn injury. , 2007, Burns : journal of the International Society for Burn Injuries.

[7]  J. Levine,et al.  TrkA and PKC-epsilon in thermal burn-induced mechanical hyperalgesia in the rat. , 2006, The journal of pain : official journal of the American Pain Society.

[8]  G. Stoll,et al.  Contralateral cytokine gene induction after peripheral nerve lesions: dependence on the mode of injury and NMDA receptor signaling. , 2005, Brain research. Molecular brain research.

[9]  C. Woolf.  Dissecting out mechanisms responsible for peripheral neuropathic pain: implications for diagnosis and therapy. , 2004, Life sciences.

[10]  S. Maier,et al.  Spinal Glia and Proinflammatory Cytokines Mediate Mirror-Image Neuropathic Pain in Rats , 2003, The Journal of Neuroscience.

[11]  S. Maier,et al.  A new model of sciatic inflammatory neuritis (SIN): induction of unilateral and bilateral mechanical allodynia following acute unilateral peri-sciatic immune activation in rats , 2001, Pain.

[12]  M. Rowbotham,et al.  Capsaicin evoked pain and allodynia in post-herpetic neuralgia , 2000, Pain.

[13]  G. Strichartz,et al.  Differential efficacy of intravenous lidocaine in alleviating ipsilateral versus contralateral neuropathic pain in the rat , 1999, Pain.

[14]  P. Wall,et al.  Does the right side know what the left is doing? , 1999, Trends in Neurosciences.

[15]  T. Yaksh,et al.  A novel model of primary and secondary hyperalgesia after mild thermal injury in the rat , 1998, Neuroscience Letters.

[16]  R. Forget,et al.  Tactile, thermal and pain sensibility in burned patients with and without chronic pain and paresthesia problems , 1998, Pain.

[17]  J. Difede,et al.  Determinants of pain expression in hospitalized burn patients , 1997, PAIN.

[18]  G. Bennett,et al.  Extra-territorial pain in rats with a peripheral mononeuropathy: mechano-hyperalgesia and mechano-allodynia in the territory of an uninjured nerve , 1994, Pain.

[19]  R. Melzack,et al.  Pain and paresthesia in patients with healed burns: an exploratory study. , 1991, Journal of pain and symptom management.

[20]  R Melzack,et al.  The pain of burns: characteristics and correlates. , 1989, The Journal of trauma.

[21]  James N. Campbell,et al.  EVIDENCE FOR DIFFERENT MECHANISMS OF PRIMARY AND SECONDARY HYPERALGESIA FOLLOWING HEAT INJURY TO THE GLABROUS SKIN , 1984 .

[22]  Y. Youn,et al.  The role of mediators in the response to thermal injury , 2005, World Journal of Surgery.

[23]  D. Heimbach,et al.  Comparison of patient satisfaction and self-reports of pain in adult burn-injured patients. , 2003, The Journal of burn care & rehabilitation.

[24]  G. Roberts.  Management of pain and anxiety , 1997 .

[25]  M. Friedman,et al.  The burn as a continuous traumatic stress: implications for emotional treatment during hospitalization. , 1994, The Journal of burn care & rehabilitation.