Alan David Kaye and Scott Francis Davis (eds.)Principles of Neurophysiological Assessment, Mapping, and Monitoring201410.1007/978-1-4614-8942-9_22
© Springer Science+Business Media New York 2014
22. New Vistas: Small-Pain-Fibers Method of Testing for Spinal Cord Assessment in Pain States
(1)
Departments of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Cente, New Orleans, LA 70112, USA
(2)
Interim Louisiana State University, Hospital and Ochsner Kenner Hospital, New Orleans, LA, USA
Abstract
Patients present to pain clinics for a variety of problems. In fact, overall, the number one complaint in any physician office is pain. At times, the diagnosis and treatment of a given pain syndrome can be challenging. In any physical examination involving a chronic pain patient, sensory neurological examination is important. It is important to know the evolution of nerve testing and to differentiate small-pain-fibers method of testing from previous techniques. In the 1940s, a logical approach to the sensory examination was identified with defined surface areas highly correlated with specific anatomic dermatomes. These dermatomes are associated with specific nerve roots and are very useful for the clinician attempting to ascertain the source of a pain generator. The concept of current perception threshold was later developed to measure the level of sensory deficit. There was significant variability associated with this diagnostic technique, which involved changing skin resistance. These limitations led to further evolution and development of sensory conduction testing.
Introduction
Patients present to pain clinics for a variety of problems. In fact, overall, the number one complaint in any physician office is pain. At times, the diagnosis and treatment of a given pain syndrome can be challenging. In any physical examination involving a chronic pain patient, sensory neurological examination is important. It is important to know the evolution of nerve testing and to differentiate small-pain-fibers method of testing from previous techniques. In the 1940s, a logical approach to the sensory examination was identified with defined surface areas highly correlated with specific anatomic dermatomes. These dermatomes are associated with specific nerve roots and are very useful for the clinician attempting to ascertain the source of a pain generator. The concept of current perception threshold was later developed to measure the level of sensory deficit. There was significant variability associated with this diagnostic technique, which involved changing skin resistance. These limitations led to further evolution and development of sensory conduction testing.
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