Liquid cooling system for the vibro-tactile threshold device.

Vibrotactile threshold testing has been used to investigate activation of human somatosensory pathways. A portable vibrotactile threshold testing device called the Vibrotactile Threshold Evaluator for the Workplace (VTEW) was designed for screening of carpal tunnel syndrome in the workplace, and initially contained a small fan for cooling. During subject testing, the device is operated intermittently, which causes the linear actuator to warm the tactile probe. The probe causes discomfort for some subjects. During testing, the probe heated to 42 °C within 90 seconds of continuous operation. A liquid cooling system was implemented to dissipate heat from the probe. The liquid cooling system maintains a steady state temperature of 36 °C for continuous actuation of the probe. The liquid cooling system is capable of maintaining a safe operating temperature, without adding erroneous vibrations to the device. However, the cooling system deters the portability of the device. Further research will investigate how to make the liquid cooling system portable and implements vibrotactile threshold testing in the workplace to quickly evaluate whether or not a person has early symptoms of carpal tunnel syndrome.

Development of a carpal tunnel syndrome screening method using structured interviews and vibrotactile testing.

Carpal tunnel syndrome (CTS) is a debilitating and expensive health problem. An inexpensive screening method that would differentiate between people who do not have CTS and those that may have CTS would be useful. The screening methodology investigated here had two phases: a structured interview and provocative vibrotactile testing (VT). The control group (n = 36) was composed of asymptomatic college students and faculty, the case group was composed of patients currently visiting an occupational medicine clinic for symptoms consistent with CTS. The case group was subdivided into positive and negative for nerve conduction latency, NCL+ (n = 21) and NCL- (n = 13), respectively. Using a scored, structured interview, 33 of the controls and none of the symptomatic cases were identified as non-CTS. The results from the provocative flexion VT indicated that if the difference between the age corrected baseline and the threshold at 15 minutes is 15 microm or more, the subject was likely to be NCL+ (odds ratio 12.6, 95% CI 3.8 to 41.8). Further research may improve this screening methodology to not only determine whether or not a person has CTS, but also to determine the level of median nerve impingement or damage.

Comparison of paclitaxel and cisplatin effects on the slowly adapting type I mechanoreceptor.

Cisplatin and paclitaxel are two of the most widely used chemotherapy drugs for the treatment of several forms of cancer. Both agents produce significant levels of peripheral neuropathy that can result in changes of treatment regimen. Although there have been recent efforts to understand the effects of these agents on nociceptor populations, little study has been made on their effects on large afferent populations. Here we report acute and chronic effects of paclitaxel and cisplatin administration on the type I mechanoreceptor using a skin-nerve preparation in rat and a standardized mechanical stimulus to compare mechanoreceptor response before and after treatment. In a control preparation, suppression of type I mechanoreceptor response during 2-min, arterial infusion of paclitaxel or cisplatin was significant for paclitaxel (28%, 1 microM; 33%, 10 microM; p<0.025), but not cisplatin (9%, 500 microM; 19%, 5 mM; p>0.05). Response returned to baseline within a 2-min washout period. Following pretreatment with paclitaxel or cisplatin, baseline response was significantly reduced from control animals. In addition, unlike the control preparation, a subsequent infusion of paclitaxel induced prolonged response suppression. Nerve fascicles innervating the preparation showed significant reduction in conduction velocity relative to control (cisplatin pretreatment: Abeta, 22%, p<0.01; C-fiber, 33%, p<0.01. paclitaxel pretreatment: Abeta, 17%, p<0.05; C-fiber, 23%, p<0.05). It was concluded that chronic paclitaxel or cisplatin treatment not only significantly alters the type I mechanotransduction process, but also increases susceptibility of the type I ending to further paclitaxel exposure.

Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions.

UNLABELLED: This paper advances a psychophysiological systems view of pain in which physical injury, or wounding, generates a complex stress response that extends beyond the nervous system and contributes to the experience of pain. Through a common chemical language comprising neurotransmitters, peptides, endocannabinoids, cytokines, and hormones, an ensemble of interdependent nervous, endocrine, and immune processes operates in concert to cope with the injury. These processes act as a single agent and comprise a supersystem. Acute pain in its multiple dimensions, and the related symptoms that commonly occur with it, are products of the supersystem. Chronic pain can develop as a result of unusual stress. Social stressors can compound the stress resulting from a wound or act alone to dysregulate the supersystem. When the supersystem suffers dysregulation, health, function, and sense of well-being suffer. Some chronic pain conditions are the product of supersystem dysregulation. Individuals vary and are vulnerable to dysregulation and dysfunction in particular organ systems due to the unique interactions of genetic, epigenetic and environmental factors, as well as the past experiences that characterize each person. PERSPECTIVE: Acute tissue injury activates an ensemble of interdependent nervous, endocrine, and immune processes that operate in concert and comprise a supersystem. Some chronic pain conditions result from supersystem dysregulation. Individuals vary and are vulnerable to dysregulation due to the unique interactions of genetic, epigenetic, and environmental factors and past experiences that characterize each person. This perspective can potentially assist clinicians in assessing and managing chronic pain patients.

Effects of prolonged wrist flexion on transmission of sensory information in carpal tunnel syndrome.

UNLABELLED: Carpal tunnel syndrome presents a constellation of symptoms which include discomfort (eg, pain, paraesthesia) and diminished sense of touch. This exploratory study simultaneously measured changes in tactile threshold and discomfort ratings during prolonged wrist flexion in symptomatic patients from a rehabilitation clinic and from a control population. Prolonged (15 min) wrist flexion significantly increased tactile threshold and discomfort ratings above baseline levels in both symptomatic and control populations. Sixty-two percent of the symptomatic sample was found to have abnormal conduction latency. Tactile threshold in symptomatic subjects with normal conduction latency (n = 13) did not differ significantly from control subjects (n = 36) at baseline but showed significant elevation during wrist flexion. In contrast, subjects with abnormal conduction latency (n = 21) exhibited significant elevation relative to control subjects at baseline and throughout wrist flexion as well as a slower recovery after flexion. Conduction latency correlated with baseline (r = .52, P < .0001) and 15-min (r = .67, P < .0001) tactile threshold for the entire subject population, as well as 15-min threshold (r = .53, P = .013) for the subpopulation with abnormal conduction latency. At 2.5 min after flexion, correlation was significant for whole (r = .64, P < .0001) and abnormal conduction latency (r = .58, P = .0063) samples. Regression slope of tactile threshold versus conduction latency was significantly greater than zero and did not differ significantly from linearity. The study demonstrates that increases in mechanosensory threshold and discomfort ratings during prolonged wrist flexion are more profound (and recovery less rapid) in patients with electrophysiologic evidence of injury. PERSPECTIVE: This study demonstrates a provocative procedure that enhances the symptoms of carpal tunnel syndrome. This measure may help clinicians discriminate median nerve compression from other types of peripheral nerve injury and help researchers investigate the impact of mechanical stress, tissue compression, and vascular stasis on compression-related neuropathy.

Substance P axons and sensory threshold increase in burn-graft human skin.

BACKGROUND: Our knowledge of afferent nerve fiber reinnervation of grafted skin following third-degree burn is limited by a lack of quantitative histological and psychophysical assessment from the same cutaneous area. The current study compares fiber profile and functional recovery measurements in injured and control skin from the same subject. MATERIALS AND METHODS: Nerve regeneration and modality-specific sensory thresholds were compared using immunocytochemical labeling with protein gene product 9.5 antibody to stain all axons and anti-substance P to label substance P axons (which are predominantly unmyelinated), as well as computerized instrumentation to obtain psychophysical estimates. RESULTS: Compared to control skin, threshold measures of pinprick (P < 0.001), warming (P < 0.001), touch (P < 0.001), and vibration (P < 0.01) were significantly elevated in burn-graft skin and correlated with histological analysis of skin biopsies obtained from the same site. Immunohistochemical staining of all axons innervating the dermis and epidermis revealed a significant reduction in burn-graft relative to control skin (54% decrease, P < 0.0001). In contrast, the incidence of substance P nerve fibers was significantly elevated in burn-graft (177% increase, P < 0.05) and appeared to correlate with patient reports of pruritus and pain. CONCLUSIONS: Observations support the hypothesis that sensory regeneration is fiber-size-dependent in burn-graft skin. The findings that substance P fiber growth increased while total fiber count decreased and that thermal threshold showed the greatest degree of functional recovery suggest that unmyelinated neurons have the greater ability to transverse scar tissue and reinnervate grafted skin following third-degree burn injury.

5-HT2 and 3 receptor antagonists suppress the response of rat type I slowly adapting mechanoreceptor: an in vitro study.

Previous experiments have shown an increase in rat type I mechanoreceptor responsiveness during arterial serotonin (5-hydroxytryptamine) infusion and the presence of serotonin immunostaining in Merkel cells. The current findings demonstrate that the 5-HT(2) antagonists ritanserin and ketanserin, as well as the 5-HT(3) antagonist MDL 72222, reduce type I response to a standardized mechanical stimulus in an in vitro skin preparation. In addition, ritanserin blocked the enhancement of type I response produced by 5-HT. These experiments suggest that serotonin is released during mechanical distortion of the Merkel cell membrane and alters action potential generation by the type I ending. In addition, it is possible that serotonin, released from outside the type I complex, influences mechanoreceptor responsiveness. For example, serotonin generated during inflammatory events could enhance type I response to mechanical stimulation and thereby increase symptoms of mechanical allodynia.