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Objectives: The aim of the study was to determine whether various transient sensory and neuropsychological symptoms (SNS) were associated with migraine using a custom questionnaire., Methods: In this hypothesis-generating case-control study, the frequencies of transient SNS in 219 patients with migraine (149 without aura and 70 with aura) were compared with 161 age- and sex-matched healthy controls using a custom questionnaire. Patients from a tertiary academic headache center in Hamburg were contacted by regular mail. Healthy controls without a history of migraine were recruited by means of a screening questionnaire and consecutively approached by e-mail., Results: The presence of both migraine and aura was associated with significantly higher frequencies of autokinesis, metamorphopsia, dyschromatopsia, cinematographic vision, illusionary visual spread, and synesthesia (for all comparisons: corrected p < 0.05). Double vision, inverted 2- and 3-dimensional vision, and altered perception of body weight and size were found more often in patients with migraine without aura than in those with aura. In contrast, aura was associated with the occurrence of visual splitting and corona phenomenon (for all comparisons: corrected p < 0.05). No relevant association with migraine was found for micropsia and macropsia, teleopsia and pelopsia, inverted vision, out-of-body experience, Doppelgänger phenomenon, complex visual hallucinations, and altered perception of body position in space., Conclusions: The observed SNS seem to belong to a physiologic spectrum of multisensory phenomena. Some of these phenomena were significantly accentuated in patients with migraine and may therefore be termed migraine trait symptoms. However, these results will have to be confirmed in a prospective study with face-to-face interviews.

Purpose: To examine the capability and performance of children with sensory processing disorders (SPD) compared with children who are developing typically and those with physical disabilities (PD)., Methods: Participants included parents/caregivers of 81 children ranging in age from 1 to 7.3 years; 57% were boys. The child's therapist interviewed the parents using the Pediatric Evaluation of Disability Inventory (PEDI) to measure functional performance., Results: Children with SPD demonstrated significant differences from children in the other groups in functional skills and caregiver assistance within 3 domains (self-care, mobility, social function)., Conclusions: The PEDI can be used to (1) identify functional delays in young children with SPD, which can affect participation in age-appropriate self-care, mobility, and social skills, and (2) determine appropriate referrals for early intervention.

Objectives: The aim of the study was to describe the relation between sensory issues and medical complexity in a series of patients presenting to an outpatient multidisciplinary feeding team for evaluation, by a standardized measure of sensory-processing abilities., Methods: A retrospective chart review of all of the patients seen from 2004 to 2009 on 2 key variables: medical diagnostic category and short sensory profile (SSP) score., Results: On the SSP, 67.6% of children scored in the clinical ("definite difference") range. The most common diagnostic categories were developmental (n = 23), gastrointestinal (n = 16), and neurological (n = 13). Behavioral and cardiorespiratory medical diagnostic categories were significantly related to SSP total score and SSP definite difference score., Conclusions: Children who present for feeding evaluation do indeed tend to have clinically elevated scores regarding sensory processing, and these elevated scores are significantly related to certain medical diagnostic categories. Future research is needed to determine why these significant relations exist as well as their implications for treatment of feeding-related issues.

Patients with chronic pain disorders frequently show nondermatomal somatosensory deficits (NDSDs) that are considered to be functional. Typically, NDSDs show quadratomal or hemibody distribution ipsilateral to the areas of chronic pain. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition and the International Classification of Diseases, 10th revision, such functional somatosensory deficits are classified in the chapter "conversion disorder." Many publications also used the term "hysterical sensory loss." However, doubts are increasing about this one-sided psychiatric view. We aimed to better characterize the biopsychosocial factors associated with NDSDs. Therefore, we compared 2 groups of inpatients with chronic pain disorder, of whom 90 suffered from NDSDs and 90 did not. The patients with NDSDs all showed widespread somatosensory deficits with hemibody distribution. On logistic regression analysis, history of a prior physical trauma was positively predictive for patients with NDSDs. Personality disorder and adverse childhood experiences were positively predictive for the control group with chronic pain disorders without NDSDs. The frequencies of comorbid depression and anxiety disorder did not differ statistically between groups. In conclusion, pain patients with NDSDs are, psychopathologically, by no means more noticeable personalities than patients with chronic pain disorder without NDSDs. Similar to complex regional pain syndromes, we assume a multifactorial etiology of NDSDs, including stress. Based on our observations, terms like "hysteric" should not be applied any longer to patients with NDSDs who suffer from chronic pain., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Although posttraumatic stress disorder (PTSD) is associated with chronic pain, preliminary evidence suggests reduced experimental pain sensitivity in this disorder. The questions addressed in the present study were whether pain perception would also be reduced in PTSD patients who are not suffering from chronic pain symptoms, and whether a reduction in pain sensitivity would also be present in combat veterans who did not develop PTSD. For this, we determined thermal detection and pain thresholds in 10 male combat-related PTSD patients, 10 combat control subjects (no PTSD) and 10 healthy controls without combat experience. All subjects were pain free. First, we measured thermal sensory thresholds with ramped heat and cold stimuli using the method of limits. Ramped thermal sensory stimulation revealed no deficits for the detection of (non-noxious) f2.1thermal stimuli between groups. In contrast, heat and cold pain thresholds in both combat groups (PTSD and combat controls) were significantly increased compared to healthy controls. However, these stimuli could not distinguish between the two groups due to ceiling effects. When using longer-lasting heat stimulation at different temperatures (30s duration; method of fixed stimuli), we found significantly lower frequency of pain reports in PTSD patients compared with both combat and healthy controls, as well as significantly lower pain ratings. Our results suggest an association of PTSD with reduced pain sensitivity, which could be related to PTSD-related (neuro-)psychological alterations or to a pre-existing risk factor for the disorder.

Females with Irritable Bowel Syndrome (IBS) and Temporomandibular Disorder (TMD) are characterized by enhanced sensitivity to experimental pain. One possible explanation for this observation is deficiencies in pain modulation systems such as Diffuse Noxious Inhibitory Control (DNIC). In a few studies that used brief stimuli, chronic pain patients demonstrate reduced DNIC. The purpose of this study was to compare sensitivity to prolonged heat pain and the efficacy of DNIC in controls to IBS and TMD patients. Heat pain (experimental stimulus; 44.0-49.0 degrees C), which was applied to left palm, was continuously rated during three 30-s trials across three separate testing sessions under the following conditions: without a conditioning stimulus; during concurrent immersion of the right foot in a 23.0 degrees C (control); and during noxious cold immersion in a (DNIC; 8.0-16.0 degrees C) water bath. Compared to controls, IBS and TMD patients reported an increased sensitivity to heat pain and failed to demonstrate pain inhibition due to DNIC. Controls showed a significant reduction in pain during the DNIC session. These findings support the idea that chronic pain patients are not only more pain sensitive but also demonstrate reduced pain inhibition by pain, possibly because of dysfunction of endogenous pain inhibition systems.

Objective: To evaluate sensory function in the unaffected hand of unilateral stroke patients., Background: Ipsilateral motor deficits have been described in stroke patients, but sensory function has usually been reported to be normal in the unaffected limbs., Method: Twenty-five patients (19 males, 6 females, 58.24+/-11.11 y old) with first-ever stroke, in the chronic phase (mean interval after stroke: 43.8+/-55.4 mo), who fulfilled the inclusion criteria, and 25 age-matched and sex-matched healthy control subjects (19 males, 6 females, 58.60+/-11.32 y old) participated in the study. Ipsilateral hand sensory function was assessed with a Moving Touch-Pressure test; motor performance was evaluated by the Box and Block test and grip strength. The examiner was not blinded to the subject's neurologic status., Results: Stroke patients had a mean Moving Touch-Pressure score of 79.77%+/-10.74% whereas the control group had a mean score of 89.10%+/-8.09% (P<0.01). Mean Box and Block scores were 58.4+/-8.27 and 68.08+/-8.98, respectively (P<0.01)., Conclusions: In addition to motor dysfunction, decreased sensitivity to moving tactile stimuli may contribute to clumsiness of the unaffected arm of unilateral stroke patients.

Objective: To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model., Methods: Prospective randomized placebo-controlled trial conducted in the inpatient General Clinical Research Center between May 2003 and May 2005 involving adults with painful HIV-associated sensory neuropathy. Patients were randomly assigned to smoke either cannabis (3.56% tetrahydrocannabinol) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days. Primary outcome measures included ratings of chronic pain and the percentage achieving >30% reduction in pain intensity. Acute analgesic and anti-hyperalgesic effects of smoked cannabis were assessed using a cutaneous heat stimulation procedure and the heat/capsaicin sensitization model., Results: Fifty patients completed the entire trial. Smoked cannabis reduced daily pain by 34% (median reduction; IQR = -71, -16) vs 17% (IQR = -29, 8) with placebo (p = 0.03). Greater than 30% reduction in pain was reported by 52% in the cannabis group and by 24% in the placebo group (p = 0.04). The first cannabis cigarette reduced chronic pain by a median of 72% vs 15% with placebo (p < 0.001). Cannabis reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli (p < or = 0.05) but appeared to have little effect on the painfulness of noxious heat stimulation. No serious adverse events were reported., Conclusion: Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain.

Patients with peripheral arterial disease (PAD) may develop a broad range of peripheral nerve dysfunctions including pain and sensory deficiencies due to chronic ischemia mostly involving the lower limbs. To investigate the degree of sensory abnormalities in such patients quantitative sensory testing (QST) might be a useful tool. Forty-five patients and 20 controls were enrolled in the present study and underwent QST according to the protocol of the German Research Network on Neuropathic Pain. PAD was graded according to the Rutherford classification. PAD patients were divided into two groups: 16 patients with critical limb ischemia (severe PAD) and 29 patients with intermittent claudication (moderate PAD). QST revealed impaired cold and warm detection, increased mechanical and vibration detection thresholds, and increased perceptual wind-up on the affected leg (all p<0.001). Paradoxical heat sensation (p<0.05) and dynamic mechanical allodynia (p<0.01) were also observed. Subgroup analysis of patients without diabetes (control n=20, moderate PAD n=21, severe PAD n=8) confirmed most of these findings. In patients with severe PAD, sensory deficits were more pronounced than in patients with moderate PAD and were detected even in the face. These data indicate that QST can detect sensory abnormalities in PAD patients. While the pattern of decreased perception suggests deafferentation for Abeta-, Adelta-, and C-fiber inputs, the presence of allodynia suggests that central sensitization also plays a role in the pain state of PAD patients. Subgroup analysis points towards a PAD-associated peripheral neuropathy independent of diabetes.

Background: Prophylactic mastectomy with breast reconstruction is a risk-reducing strategy for women at increased risk of breast cancer. It remains a very radical intervention, and long-term data on satisfaction are insufficiently available. In the present follow-up study, the authors assess satisfaction with prophylactic mastectomy and breast reconstruction and its impact on sexual relationships., Methods: The authors conducted a retrospective study using a short self-report questionnaire administered to 114 genetically predisposed women who underwent prophylactic mastectomy and breast reconstruction mainly by subpectorally implanted silicone prostheses performed at one institution., Results: The median follow-up time between prophylactic mastectomy/breast reconstruction and completion of the questionnaire was 3 years. Sixty percent of all participants were satisfied with the result of prophylactic mastectomy/breast reconstruction. Satisfaction was significantly and negatively correlated with perceived lack of information, experienced complications, ongoing complaints, whether or not the reconstructed breasts feel "like your own," and not choosing this type of breast reconstruction again. Adverse effects in the patient's sexual relationship were strongly correlated with perceived lack of information, discrepant expectations, ongoing complaints and limitations, whether or not the reconstructed breasts feel "like your own," altered feelings of femininity, partner's negative perception on femininity and sexuality, and not choosing this type of breast reconstruction again., Conclusions: A majority of women would choose the procedure again, but adverse effects and untoward changes in the perception of the sexual relationship need to be addressed in the counselling of women at high risk, to optimize an informed choice and enable adequate adjustment postoperatively.

Study Design: An observational prospective cohort study in general practice., Objectives: To describe the clinical course and to identify predictors of recovery, changes in pain intensity, and changes in functional disability in patients with neck or shoulder symptoms at 3- and 12-month follow-up., Summary of Background Data: Knowledge on the clinical course and predictors of outcome in neck and shoulder symptoms is limited. Such knowledge would facilitate treatment decisions and may help to inform patients about their prognosis., Methods: Four hundred and forty-three patients who consulted their general practitioner with neck or shoulder symptoms participated in the study. Baseline scores of pain and disability, symptom characteristics, sociodemographic and psychological factors, social support, physical activity, general health, and comorbidity were investigated as possible predictors of recovery, changes in pain intensity, and changes in functional disability using multiple regression analyses., Results: The recovery rate was low; 24% of the patients reported recovery at 3 months and 32% reported recovery at 12-month follow-up. Duration of the symptoms before consulting the GP and a history of neck or shoulder symptoms increased the probability of an unfavorable outcome. Furthermore, less vitality and more worrying were consistently associated with poorer outcome after 3 and 12 months. The area under the receiver-operator characteristic curve for the model predicting recovery was 0.8 at 3 months and 0.75 at 12 months. The explained variance of the models on pain and functional disability ranged from 43 to 54%., Conclusions: The results found in this study indicate that besides clinical characteristics, psychological factors also predict the outcome of neck and shoulder symptoms.

Objective: To assess the frequency and disability caused by nonmotor fluctuations (NMF) in PD., Methods: A structured questionnaire was administered to 50 patients with PD with motor fluctuations (MF), focused on 54 nonmotor symptoms classified in three subgroups: 26 dysautonomic, 21 cognitive and psychiatric, and seven pain/sensory NMF. The link between each NMF and the motor state was determined. Patients were asked to grade their disability from 0 (no disability) to 4 (maximum discomfort) and to specify which kind of fluctuation subgroup (motor or nonmotor) was the most incapacitating. A statistical analysis was performed to determine the frequency of each NMF and to determine whether the level of disability resulting from NMF could be correlated to the main characteristics of the population., Results: All patients had had at least one type of NMF, most of which were associated with the "off" state. Anxiety (66%), drenching sweats (64%), slowness of thinking (58%), fatigue (56%), and akathisia (54%) were the most frequent NMF. Some symptoms such as anxiety or dyspnea correlated with a greater level of disability. The total number of NMF was found to be correlated with the motor disability. Incapacity resulting from the dysautonomic fluctuations was also significantly correlated with levodopa treatment. Surprisingly, 28% of the patients stated that NMF involved a greater degree of disability than MF., Conclusion: Nonmotor fluctuations are frequent and debilitating in PD.

Cerebral damage may induce a delusional belief so that patients claim that their limbs contralateral to the side of the lesion belong to someone else (somatoparaphrenia). This disorder, which is not due to a general delirium, is frequently accompanied by the inability to feel tactile sensations in the 'non-belonging' part of the body. We report the unique case of a patient with somatoparaphrenia in whom dense tactile imperception in the left hand dramatically recovered when she was instructed to report touches delivered to her niece's hand, rather than to her own hand. We suggest that, through this verbal instruction, the mismatch between the patient's belief about the ownership of her left hand and her ability to perceive touch on it was transiently recomposed. This is evidence that apparently elementary deficits, such as hemianesthesia, and selective delusional behavior, such as somatoparaphrenia, may both originate from an impairment of the body image.

This study was undertaken to find out whether pain contributes to abnormal posture of the foot in rats displaying neuropathic pain behaviors, and if so, whether there is a specific abnormality which reflects the level of pain. We used a rat model of neuropathic pain which is produced by tightly ligating the L5 and L6 spinal nerves just distal to the dorsal root ganglion (DRG). The operation produced neuropathic pain behaviors along with abnormal foot posture as has been shown previously. On the other hand, injury to the same somatic sensory and motor fibers at a more proximal site by sectioning dorsal and ventral roots of the same segments did not produce neuropathic pain behaviors. Rats with dorsal and ventral rhizotomies showed an abnormality of foot posture despite the absence of neuropathic pain behaviors. However, the abnormality in these rats was less severe and lasted for a shorter period of time as compared to rats with spinal nerve ligation. This suggests that peripheral nerve injury in our rat neuropathic pain model produces a foot postural abnormality partially due to motor deficit. However, there is an additional component of the abnormality that is related to sensory function, possibly pain. Close examination of the data indicate that there is no single obvious abnormal foot posture which exclusively represents motor deficit or sensory abnormality. Rather, neuropathic rats are likely to display abnormal foot posture as a result of a complex mixture of motor and sensory abnormalities.

The clinical correlates of suicidal thoughts were examined among a group of 301 patients with acute stroke. A total of 20 patients (6.6%) had suicidal thoughts. Previous history of stroke was associated with suicidal thoughts. Suicidal thoughts, however, were not related to severity of physical impairment. Most patients with suicidal thoughts met criteria for major depression. Other risk factors included younger age, poor social support, sensory deficit, and impaired cognitive function. Patients with suicidal plans had depression characterized by social withdrawal and brooding and self blame. Early identification of risk factors including the existence of depression may lead to effective therapeutic intervention.

Background and Purpose: Many patients suffering from stroke exhibit denial of illness. As part of this symptom complex we observed denial of eye closure. We therefore aimed to document the frequency and phenomenology of denial of eye closure in acute stroke., Methods: Denial of eye closure was sought in 43 cases of denial of illness from a series of 400 acute strokes. Subjects underwent a neurological examination, and audiotaped interviews were performed during which they were asked to finger count through their closed eyes and their denial was challenged., Results: Five of 43 patients with denial of hemiplegia after acute stroke were also found to have denial of eye closure (12%). Denial of eye closure was associated with drowsiness and in all but one patient with disorientation. In the three cases with imaging or autopsy data available, lesions were moderate to large, in the right hemisphere, and involved the frontal lobe. Three subjects confabulated as to what they saw through their closed eyes. One subject mislocalized the hospital closer to her home., Conclusions: Denial of eye closure occurs in a minority of patients with denial of illness after acute stroke. This phenomenon sheds light on denial as a whole and cannot easily be accounted for by unilateral explanations, such as inattention to one half of the body or loss of sensory input. There are aspects of denial, such as denial of eye closure, mislocalization, and the delusional intensity of beliefs, that can only be understood in cognitive terms.