Cold intolerance and neuropathic pain after peripheral nerve injury in upper extremity

Abstract

Background and aims Cold intolerance and pain can be a substantial problem in patients with peripheral nerve injury. We aimed at investigating the relationships among sensory recovery, cold intolerance and neuropathic pain in patients affected by upper limb peripheral nerve injury (Sunderland type V) treated with microsurgical repair, followed by early sensory re‐education. Methods In a cross‐sectional clinical study, 100 patients [male/female 81/19; age 40.5 ±14.8 year and follow‐up 17 ±5 months, mean ± SD], with microsurgical nerve repair and reconstruction in the upper extremity and subsequent early sensory re‐education, were evaluated, using Cold Intolerance Symptoms Severity questionnaire – Italian version (CISS‐it, cut‐off pathology >30/100 points), Cold Intolerance Symptoms Severity questionnaire – 12 item version [CISS‐12, 0 ‐ 46 points – grouping: healthy that means no cold intolerance (0‐14), mild (15‐24), moderate (25‐34), severe (35‐42), very severe (43‐46) cold intolerance], probability of neuropathic pain (DouleurNeuropathique; DN4> 4/10), deep and superficial sensibility, tactile threshold (monofilaments) and two‐point discrimination (cut off S2; Medical Research Council scale for sensory function; MRC‐scale). Results A high CISS score is associated with possible neuropathic pain (DN4 ≥). Both a low CISS‐it score (i.e.<30) and DN4<4 is associated with good sensory recovery (MRC≥2). Interpretation Patients affected by upper limb peripheral nerve injuries with higher CISS scores more often suffer from cold intolerance and neuropathic pain, and the better their sensory recovery is, the less likely they are to suffer from cold intolerance and neuropathic pain.