Diagnosis of neuropathic pain
Pain due to damage to the nervous system
Neuropathic pain is a type of chronic pain that results from injury or dysfunction of the nervous system, either peripherally (nerves) or centrally (spinal cord or brain).
Unlike “normal” (nociceptive) pain, which occurs in response to an actual physical injury (such as a burn or a blow), neuropathic pain is not caused directly by tissue damage, but rather by a disruption in the way nerves transmit signals to the brain.
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Diagnostic tests for neuropathic pain
Thermotest
The Thermotest is a test that evaluates the patient’s thermal sensitivity (heat and cold), through controlled stimulation of the skin with temperature changes.
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What it’s used for:
Evaluating small fiber neuropathies (not visible on EMG/ENG).
Diagnosis of neuropathic pain of peripheral or central origin.
Study of complex pain syndromes (such as fibromyalgia or complex regional pain syndrome).
Assessment of sensory disturbances in:
• Diabetes
• Polyneuropathies
• Multiple sclerosis
• Spinal cord injuries.
Potential CHEPS
CHEPS stands for “Contact Heat Evoked Potentials.” It is an objective test to study the function of Aδ and C fibers, responsible for thermal pain (heat) and fine sensation.
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Purpose: To evaluate
Thermal and nociceptive pathways (especially small fibers).
Central pain conduction, from the skin to the cerebral cortex.
Uses:
Diagnosis of small fiber neuropathies when EMG/ENG is normal.
Study of neuropathic pain.
Demyelinating diseases (such as multiple sclerosis).
Functional evaluation of nociceptive pathways after spinal cord injuries, trauma, etc.
Use in forensic neurophysiology and assessment of sequelae.
Pain-Related Evoked Potentials (PREPS)
PREPS assess the function of nociceptive pathways through brief electrical stimuli, allowing the study of how the nervous system processes pain.
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What it’s used for:
To evaluate the function of Aδ fibers responsible for the rapid transmission of pain.
To detect alterations in the central or peripheral nociceptive pathway.
To complement other studies when neuropathic pain is suspected.
To assess the functional integrity of the pain sensory system.
Useful in the study of:
• Small fiber neuropathies
• Neuropathic pain of peripheral or central origin
• Functional pain syndromes
• Demyelinating diseases
• Pain abnormalities with normal EMG/ENG
Microneurography
Microneurography directly records the electrical activity of individual nerve fibers using microelectrodes, providing an accurate assessment of the peripheral nervous system.
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What it’s used for:
Measuring the activity of sensory and sympathetic fibers at an individual level.
Identifying alterations in neural transmission that are not detected by conventional tests.
Analyzing the function of the autonomic and somatosensory nervous systems with high precision.
Studying abnormal spontaneous activity associated with neuropathic pain.
Useful in the study of:
• Small fiber neuropathies
• Complex neuropathic pain
• Autonomic nervous system disorders
• Spontaneous pain syndromes or allodynia
• Advanced investigation of peripheral nerve function