Somatosensory rehabilitation of pain

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The Somatosensory Rehabilitation of Neuropathic Pain, is a method whose aim is to treat conditions of a reduced sense of touch or sensation (hypoesthesia) in order to decrease neuropathic pain. Neuropathic pain, with a prevalency of 6.9% of the general population, represents an important public health problem.[1] e.g. Carpal Tunnel Syndrome (CTS) concerns 2.7% of the general population.;[2] i.e. Complex Regional Pain Syndrome (CRPS) concerns 26/100,000 person-years of the general population.[3] Patients with chronic pain need every possible therapy to battle the pain. Chronic pain is not a symptom but a syndrome in its own right, and requires therapists from a wide range of disciplines.So too, transcutaneous electrical nerve stimulation and other physical therapy procedures emerged rapidly, bringing substantial pain relief to large numbers of people.[4]


In 1869, the French surgeon Jean Joseph Emile Létiévant[5] was the first to map the altered sensibility of the cutaneous sense : aesthesiography. In 1872, after the American Civil War the American neurologist Silas Weir Mitchell[6] was the first to observe the correlation between the altered cutaneous fibres and the burning pain that he named causalgia. For him the cohabitation of altered cutaneous fibres and non-altered was the etiology of this neuropathic pain symptom. In 1909, the British surgeons Wilfred Trotter and H. Morriston Davies studied on volunteers (themselves) the sensory recovery in altered sensibility of the skin.[7] In 1915, during World War I the German surgeon Paul Hoffmann[8] and the French neurologist Jules Tinel[9] discovered a sign of sensory recovery: the Hoffmann-Tinel or Tinel sign. In 1954, after World War II, a council of surgeons defined a classification of sensory recovery.[10] In 1978, the hand surgeon A Lee Dellon created a new tool to follow the sensory recovery: the moving 2-point discrimination test.[11] In 1981, he published his first Textbook about the testing after nerve injury and repair and was the first to propose a re-education of sensibility.[12] In 1997, he made his concept more clear by proposing a new title for his Textbook: Somatosensory Testing and Rehabilitation.[13] In 1998, Birgit Rosen and Göran Lundborg created a new tool to test altered sensibility.[14] They proposed a multisensory treatment (auditive and somatosensory sense) and published their papers as sensory relearning.[15] Somatosensory testing is simultaneously testing and rehabilitation. To make the concept more clear, Claude J. Spicher proposed, in 2006, the concept of somatosensory rehabilitation.[16][17] As the somatosensory system is considered as the centre of one of the etiologies of neuropathic pain[18] Spicher proposed to switch the concept, in the French version of WIKIPEDIA fr:Rééducation sensitive de la douleur the concept of Somatosensory Rehabilitation into Somatosensory Rehabilitation of Pain, in order to enlighten the aim of this method, which is to reduce neuropathic pain. In 1979, Ulf Lindblom[19] – at that time the president of International Association for the Study of Pain - insisted on the fact that pain itself is the centre of concern for both the patient and the physician but the sensory abnormalities which often occur in the painful area are important as well. In 2015, as an activity in the Global Year Against Neuropathic Pain,[20] IASP Special Interest Group on Neuropathic Pain(NeuPSIG) established a committee to (1) critically evaluate the use of the grading system in the 7 years after its publication, (2) assess the usefulness and limitations of the grading system, and (3) update the grading system if required, for improved application in clinical and research settings.[21]

Somatosensory Rehabilitation of Neuropathic Pain[edit]

The aim of somatosensory rehabilitation is to increase the quality of touch or even normalize the sensation of touch in the case of neuropathic pain due to peripheral nerve lesions. Because, when hypoesthesia decreases, neuropathic pain decreases.[22][23][24][25] The assessment of partial hypoaesthesia (axonotmesis) is based on the concept of the largest cutaneous distribution of the nerve branch.[26] The first phase is the mapping which outlines the hypoaesthetic territory - aesthesiography. The second phase is the regular and rigorous assessment of the quality of hypoesthesia in terms of pressure perception threshold. This is an important part of this rehabilitation.[27][28][29]

Sometimes, the hypoaesthetic territory is masked by a patch of skin which is painful to touch and is therefore not accessible. Since 1979, this stimulus induced pain is to be called allodynia in medicine. The original definition comes from Merksey and Bogduk (1994) “pain due to a stimulus which does not normally provoke pain”.[30] In such situations, while doing the diagnostic testing of axonal lesions at the first occupational or physical therapy session, the two point discrimination test[31][32] is impossible, because it induces pain.“This conflict between hypersensitivity and hypoaesthesia is commonly seen in the clinical setting in patients with CRPS”.[33]

The presence of mechanical allodynia,[34] hinders other physical treatments. For the reason that, any contact on the hypersensitive territory, although it can be bearable in the moment, can induce several hours of a very painful post-effect or even several sleepless nights. This hypersensitivity to touch is induced by the peripheral nerve lesion of the large myelinated A-beta fibers.[35]

In other words, after a peripheral nerve lesion, aberrant sprouting occurs in the dorsal horn which can explain that a non-noxious stimulus is perceived as being noxious.[36] This is one of the explanatory models of the different mechanisms of central sensitization.


The Center where this method has started being practiced is in Fribourg Switzerland and has, since 2000 expanded to France [16], Europe, North of America, Argentina and Australia [17].


Allodynia – Distant Vibrotactile Counter Stimulation – Pressure Perception Threshold – McGill Pain QuestionnaireNeuropathic pain

See also[edit]


  1. ^ Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C (2008). "Prevalence of chronic pain with neuropathic characteristics in the general population". Pain. 136 (3): 380–87. PMID 17888574. doi:10.1016/j.pain.2007.08.013. 
  2. ^ Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I (1999). "Prevalence of carpal tunnel syndrome in a general population". JAMA. 282 (2): 153–8. PMID 10411196. doi:10.1001/jama.282.2.153. 
  3. ^ de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC (2007). "The incidence of complex regional pain syndrome: a population-based study". Pain. 129 (1–2): 12–20. PMID 17084977. doi:10.1016/j.pain.2006.09.008. 
  4. ^ Melzack R (2011). Foreword: Relief of pain and suffering endured by millions of people. e-News for Somatosensory Rehabilitation, 9(1),5 (one page).[1]
  5. ^ Spicher C, Kohut G (2001). "Jean Joseph Emile Létiévant: a review of his contributions to surgery and rehabilitation". J Reconstr Microsurg. 17 (3): 169–77. PMID 11336148. doi:10.1055/s-2001-14348. 
  6. ^ Mitchell, S.W. (1872) Injuries of Nerves and their Consequences. Philadelphia: JB Lippincott Co
  7. ^ Trotter W, Davies HM (1909). "Experimental studies in the innervation of the skin". J Physiol. 38 (2–3): 134–246. PMC 1533644Freely accessible. PMID 16992967. doi:10.1113/jphysiol.1909.sp001299. [2]
  8. ^ Hoffmann P, Buck-Gramcko D, Lubahn JD (1983). "The Hoffmann-Tinel sign". J Hand Surg Br. 18 (6): 800–5. PMID 8308447. de:Hoffmann-Tinel-Zeichen
  9. ^ Tinel, J. Nerve wounds. London: Baillère, Tindall and Cox, 1917
  10. ^ Zachary R B (1954). Results of nerve suture. In H.-J. Seddon (Ed.), Peripheral Nerve Injuries (pp. 354-388). London, England: Her Majesty's Stationery Office. Medical Research Council Special Report Series n° 282
  11. ^ Dellon AL (1978). "The moving two-point discrimination test: Clinical evaluation of the quickly adapting fiber/receptor system". J Hand Surg. 3 (5): 474–81. PMID 568154. doi:10.1016/s0363-5023(78)80143-9. 
  12. ^ Dellon AL (1981). Evaluation of Sensibility and Re-education of Sensation in the Hand. Baltimore: Williams & Wilkins [3]
  13. ^ Dellon AL. (1997). Somatosensory Testing & Rehabilitation. Bethesda Maryland: American Occupational Therapy Association [4]
  14. ^ Rosen B, Lundborg G (1998). "A New Tactile Gnosis Instrument in Sensibility Testing". J Hand Ther. 11 (4): 251–57. PMID 9862262. doi:10.1016/s0894-1130(98)80020-3. 
  15. ^ Rosen B, Bjorkman A, Lundborg G (2006). "Improved sensory relearning after nerve repair induced by selective temporary anaesthesia - a new concept in hand rehabilitation". J Hand Surg Br. 31 (2): 126–32. PMID 16352379. doi:10.1016/j.jhsb.2005.10.017. 
  16. ^ Spicher CJ. Handbook for Somatosensory Rehabilitation. Montpellier, Paris: Sauramps Médical, 2006. [5]
  17. ^ Valembois, B., Blanchard, M., Miternique, B. & Noël, L. (2006). Rééducation des troubles de la sensibilité de la main. Encyclopédie Médico-Chirurgicale (EMC) 26-064-A 10, 1-19. Paris: Elsevier [6]
  18. ^ Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J (2008). "Neuropathic pain: redefinition and a grading system for clinical and research purposes". Neurology. 70 (18): 1630–5. PMID 18003941. doi:10.1212/01.wnl.0000282763.29778.59. 
  19. ^ Lindblom U, Verrillo RT (1979). "Sensory functions in chronic neuralgia". J Neurol Neurosurg Psych. 42 (5): 422–35. PMC 490230Freely accessible. PMID 448382. doi:10.1136/jnnp.42.5.422. [7]
  20. ^ Spicher CJ (2015). "Editorial: The Global Year against Neuropathic Pain". e-News Somatosens Rehab. 12 (1): 3–7.  [8]
  21. ^ Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DL, Bouhassira D, Cruccu G, Freeman R, Hansson P, Nurmikko T, Raja SN, Rice AS, Serra J, Smith BH, Treede RD, Jensen TS (2016). "Neuropathic pain: an updated grading system for research and clinical practice". Pain. 157 (8): 1599–606. PMC 4949003Freely accessible. PMID 27115670. doi:10.1097/j.pain.0000000000000492. [9]
  22. ^ Spicher, C.J., Fehlmann, P., Maihöfner, Ch., Sprumont, P., Letourneau, E., Dyer, J.O., Masse, J., López-Solà, M., Maupas, E., Annoni, J.M. (Jan 2016). "Management Algorithm of Spontaneous Neuropathic Pain and/or Touch-evoked Neuropathic Pain illustrated by prospective observations in clinical practice of 66 chronic Neuropathic Pain Patients.". e-News Somatosens Rehab. 13 (1): 4–32. [10] [11]
  23. ^ Spicher, C.J. & Clément-Favre, S. (2008). Chronic Neuropathic Pain decreases through Somatosensory Rehabilitation. RAE : Recueil Annuel francophone belge d'Ergothérapie, 1, 25-37 [12]
  24. ^ Mathis F, Desfoux N, Sprumont P, Hecker E, Rossier P, Spicher C (Nov 2007). "Peripheral neuropathic pain relieved by somatosensory rehabilitation.". Rev Med Suisse. 3: 2745–8. PMID 18214230. [13]
  25. ^ Moseley GL, Zalucki N, Weich, K (2008). "Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain". Pain. 137: 600–608. PMID 18054437. doi:10.1016/j.pain.2007.10.021. 
  26. ^ Spicher, C.J., Desfoux, N. & Sprumont, P. Atlas des territoires cutanés du corps humain; Esthésiologie de 240 branches (2e ed.). Montpellier, Paris: Sauramps Médical, 2013 [14]
  27. ^ Frey von, M. Untersuchung über die Sinnesfunktion der Menschlichen Haut : Erste Abhandlung: Druckempfindung und Schmerz. Des XXII Bandes der Abhandlungen der mathematisch – physischen Classe der Königl. Sachsischen Gesellschaft des Wissenschaften, n°III:175-266, Leipzig: S. Hirzel,1869
  28. ^ Semmes, J., Weinstein, S., Ghent, L. & Teuber, H.L. Somatosensory changes after penetrating brain wounds in man. Cambridge, MA : Harvard University Press, 1960
  29. ^ Malenfant A, Forget R, Amsel R, Papillon J, Frigon JY, Choinière M (1998). "Tactile, thermal and pain sensibility in burned patients with and without chronic pain and paresthesia problems". Pain. 77 (3): 241–251. PMID 9808349. doi:10.1016/S0304-3959(98)00096-7. 
  30. ^ Merskey, H. & Bogduk, N. (Eds.) Classification of Chronic Pain. Seattle: IASP Task Force on Taxonomy, 1994
  31. ^ Weber, EH. (1834). De pulsu, resorptione, auditu et tactu. Leipzig: Koehler. Its 4th section is translated as: Weber, EH. (1978). Sense of Touch. London: Academic Press
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  33. ^ Lewis JS, Coales K, Hall J, McCabe CS (2011). "’Now you see it, now you do not’: sensory-motor re-education in complex regional pain syndrome.". Hand Ther. 16 (2): 29–38. doi:10.1258/ht.2011.011005. 
  34. ^ Spicher, C.J., Mathis, F., Degrange, B., Freund, P. & Rouiller, E.M. (2008). Static Mechanical Allodynia is a Paradoxical Painful Hypoaesthesia: Observations derived from neuropathic pain patients treated with somatosensory rehabilitation. Somatsens Mot Res, 25(1), 77-92. [15]
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  36. ^ Kohama I, Ishikawa K, Kocsis JD (Feb 2000). "Synaptic reorganization in the substantia gelatinosa after peripheral nerve neuroma formation: aberrant innervation of lamina II neurons by Abeta afferents.". J. Neurosci. 20 (4): 1538–49. PMC 2605372Freely accessible. PMID 10662843.