Mechanical Allodynia Definition, Assessment and Treatment
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1 See discussions, stats, and author profiles for this publication at: Mechanical Allodynia Definition, Assessment and Treatment Conference Paper June 2010 CITATIONS 0 READS author: Claude J Spicher Université de Fribourg 69 PUBLICATIONS 179 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Static mechanical allodynia (SMA) is a paradoxical painful hypoaesthesia in CRSP'patient View project All content following this page was uploaded by Claude J Spicher on 11 February The user has requested enhancement of the downloaded file.
2 Mechanical Allodynia: Definition, Assessment & Treatment Spicher, C.J. et al. (2010) Atlas des territoires cutanés; Esthésiologie de 240 branches. Montpellier, Paris: Sauramps Médical Claude Spicher, OT, Swiss HT, University Scientific Collaborator Director, Editor in Chief IFSHT Orlando, the 27 th June 2010
3 Anamnesis 1 st session: 29 / 1 / 2010 E., 17 year old female, Caucasian, au-pair, is complaining of pain in the upper extremity for 15 months Case Report (June 2010) - IFSHT Orlando
4 McGill Pain Questionnaire 1 st session: 29 / 1 / 2010 Radiating 3, Hot sensation 3, Tingling 3, Tender 2 Sub-total of sensory pains : 11 / 65 X 100 = 17 points Fearful 2, Troublesome 2 Sub-total of affective pains : 4 / 35 X 100 = 11 points Total of pains: = 15 points Case Report (June 2010) - IFSHT Orlando
5 Diagnostic Testing of Axonal Lesions Intermittent brachial neuralgia of Anterior branch of medial antebrachial cutaneous nerve with mechanical allodynia (Stage III of axonal lesions) Spicher (2006) Handbook for Somatosensory Rehabilitation
6 CONTENTS Introduction Definition Allodynia Testing Allodynia Rehabilitation Conclusion
7 Neuropathic Pain Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. «definite» «probable» «possible» can only be regarded as a working hypothesis. Treede et al. (2007) -Eur J Pain, (2008) - Neurology
8 Mechanical Allodynia Pain due to a stimulus which does not normally provoke pain Merskey & Bogduk (1979, 1994) IASP
9 CONTENTS Introduction Definition Allodynia Testing Allodynia Rehabilitation Conclusion
10 MECHANICAL CLINICAL EXAMINATION ALLODYNIA SIGNS TESTING Aesthesiography Allodynography SYNDROMES Peripheral Neuropathic Pain Syndrome Complex Regional Pain Syndrome type II With Hypoaesthesia (Stimulus Independent Pain) With Mechanical Allodynia (Stimulus Evoked Pain) Woolf & Manion (1999) Lancet
![18 ] Pain Intensity VAS 3 / 10 cm Site](/docs-images/76/73517268/images/11-3.jpg "of Stimulus Application THIS IS THE")
11 MECHANICAL ALLODYNIA TESTING ALLODYNOGRAPHY Pain due to a stimulus which does not normally provoke pain Stimulus Importance 15 grams [ mark: 5.18 ] Pain Intensity VAS 3 / 10 cm Site of Stimulus Application THIS IS THE VARIABLE TO MAP
12 ALLODYNOGRAPHY: 1 st session 29 / 1 / grams VAS: 3 / 10 cm Case Report (June 2010) - IFSHT Orlando
13 ALLODYNOGRAPHY: 1 st session 29 / 1 / grams VAS: 3 / 10 cm Anterior branch of medial antebrachial cutaneous nerve
14 Spicher, Desfoux & Sprumont (2010) Atlas des territoires cutanés
15 MECHANICAL CLINICAL EXAMINATION ALLODYNIA TESTING SIGNS Aesthesiography Allodynography Rainbow Pain Scale SYNDROMES Peripheral Neuropathic Pain Syndrome, Complex Regional Pain Syndrome type II With Hypoaesthesia (Stimulus Independent Pain) With Mechanical Allodynia (Stimulus Evoked Pain) Woolf & Manion (1999) Lancet
16 Rainbow Pain Scale V. A. S : 3 / 10 cm 1.5 grams 3.6
17 RAINBOW PAIN SCALE: 2 nd session 8.7 grams VAS: 3 / 10 cm Case Report (June 2010) - IFSHT Orlando
18 ALLODYNOGRAPHY RAINBOW PAIN SCALE 15.0 grams 8.7 grams VAS: 3 / 10 cm Case Report (June 2010) - IFSHT Orlando
19 MECHANICAL ALLODYNIA PROGNOSIS: 1 st session 60 ) Mea an Time (days Static mechanical-induced pain threshold 1.5 g (n = 19). 3.6 g (n = 35). 8.7 g (n = 41). 15 g (n = 63) Spicher et al. (2008) Somato Mot Res
20 MECHANICAL ALLODYNIA PROGNOSIS: 1 st session 60 ) Mea an Time (days Static mechanical-induced pain threshold 1.5 g (n = 19). 3.6 g (n = 35). 8.7 g (n = 41). 15 g (n = 63) Spicher et al. (2008) e-news for Somatosens
21 Rainbow Pain Scale V. A. S : 3 / 10 cm 1.5 grams 3.6
22 CONTENTS Introduction Definition Allodynia Testing Allodynia Rehabilitation Conclusion
23 MECHANICAL ALLODYNIA REHABILITATION Distant vibrotactile counter stimulation (DVCS) is at the opposite of desensitization. Objective: to progressively re-educate the patient to perceive a comfortable stimulus in a non-nociceptive manner on a territory more and more vast Tactile (at home): silk, alcantara leather, rabbit fur, Vibrotary (during therapy): Frequency 100 Hz, Amplitude 0.06mm Pharmacological: Lidocaïne (plaster or gel), Bipuvacaïne infiltration Spicher et al. (2008) Somato Mot Res
24 A Therapeutic Management B Distant Vibrotactile Counter Stimulation Rehabilitation of hyposensitivity y
25 MECHANICAL ALLODYNIA REHABILITATION COMFORTABLE Distant Counter Stimulation on: The proximal part of the territory of cutaneous distribution The territory of a «cousin» nerve and not a «neighbour» nerve The upper and/or lower segmentary level Noël & Spicher (2007) Eur Congres Paris
26 Lower W Work Zone 1 st session: 29 / 1 / 2010 Case Report (June 2010) - IFSHT Orlando
27 Cousin Work Zone 2 nd session: 12 / 2 / 2010 Medial brachial cutaneous nerve territory
28 MECHANICAL ALLODYNIA REHABILITATION COMFORTABLE Distant Counter Stimulation on: The proximal part of the territory of cutaneous distribution The territory of a «cousin» nerve and not a «neighbour» nerve The upper and/or lower segmentary level Noël & Spicher (2007) Eur Congres Paris
29 RAINBOW PAIN SCALE 3 rd session 8.7 grams VAS: 3 / 10 cm 19 / 2 / 2010 Case Report (June 2010) - IFSHT Orlando
30 RAINBOW PAIN SCALE 4 th session 8.7 grams VAS: 3 / 10 cm 26 / 2 / 2010 Case Report (June 2010) - IFSHT Orlando
31 ALLODYNOGRAPHY 4 th session Allodynography Rainbow Pain Scale 15.0 grams VAS 3 / 10 VAS: 3 / 10 cm 26 / 2 / 2010
32 Proximal Work Zone 4 th session: 26 / 2 / 2010 Case Report (June 2010) - IFSHT Orlando
33 MECHANICAL ALLODYNIA REHABILITATION COMFORTABLE Distant Counter Stimulation on: The proximal part of the territory of cutaneous distribution The territory of a «cousin» nerve and not a «neighbour» nerve The upper and/or lower segmentary level Noël & Spicher (2007) Eur Congres Paris
34 ALLODYNOGRAPHY 5 th session 15.0 grams VAS: 3 / 10 cm 5 / 3 / 2010 Case Report (June 2010) - IFSHT Orlando
35 SECUNDARY AESTHESIOGRAPHY 5 th session 15.0 grams Detection VAS: 07gram / 10 cm / 3 / 2010 Case Report (June 2010) - IFSHT Orlando
36 Aβ pain Devor (2009) Exp Brain Res Allodynia is a paradoxical painful hypo-aesthesia Spicher et al. (2008) Somatosensory & Motor Research
37 McGill Pain Questionnaire Radiating 3 [0-1], Hot sensation 3 [0-1], Tingling 3 [0-2], Tender 2 [0] Sub-total of sensory pains : 11 [4] / 65 X 100 = 17 points [6 points] Fearful 2, Troublesome 2 Sub-total of affective pains : 4 [2] / 35 X 100 = 11 points [6 points] Total of pains: 11 [4] + 4 [2] = 15 points [0-6 points] PRE 1 st session: 29 / 1 / 2010 POST 11 th session: 7 / 5 / 2010
38 CONTENTS Introduction Definition Allodynia Testing Allodynia Rehabilitation Conclusion
39 Neuropathic Pain Patient of the Upper Extremity Mechanical Allodynia Hypoaesthesia
40 CRPS type II n = 126 patients 126 patients t 49 patients 39 % 77 patients 61 % Initial Hypoaesthesia Mechanical lallodynia CRPS-SYMPOSIUM - MÜNCHEN, 19 th of September 2009
41 Brachial Neuralgia n = 81 patients t 81 Patients t 41 Patients 50 % 40 Patients 50 % Initial Hypoaesthesia Mechanical Allodynia Spicher (European Vol. 2008) - J Hand Surg, 33E (suppl. 1),
42 View publication stats unifr.ch/neuro/rouiller/somesthesie/somato.enews.php e-news for Somatosensory Rehabilitation
MANAGEMENT OF CRPS. Brachial Neuralgia n = 81 patients. CRPS type II n = 126 patients CONTENTS. Neuropathic Pain. Introduction.
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