Somatosensory rehabilitation of pain

The Somatosensory Rehabilitation of Neuropathic Pain, is an approach that assesses and treats somesthesia disorders like static mechanical allodynia in order to reduce acute or persistent neuropathic pain by addressing the related reduced sense of touch or sensation (hypoesthesia).
Background: evaluation and treatment of neuropathic pain
Neuropathic pain, with a prevalence of 6.9% of the general population, represents a very important public health problem: for example, Carpal Tunnel Syndrome (CTS) concerns 2.7% of the general population.; i.e. complex regional pain syndrome (CRPS) concerns 26/100,000 person-years of the general population. The Mayo Clinic has called for a combination of careful diagnosis and treatment to improve management for neuropathic pain conditions.
There have been centuries of research on the evaluation and treatment of neuropathic pain: that is pain arising from altered function of the nervous system. In 1869, the French surgeon Jean Joseph Emile Létiévant was the first to map the altered sensibility of the cutaneous sense. To outline the hypoaesthetic territory, the first phase consists of mapping the skin using monofilaments. The second phase is the regular and rigorous assessment of the hypoesthesia quality in terms of its pressure perception threshold.
In 1978, the hand surgeon A Lee Dellon created a new tool to follow the sensory recovery: the moving 2-point discrimination test. In 1981, Dellon published his first Textbook about the testing after nerve injury and repair and was the first to propose a re-education of sensibility.
In 1998, Birgit Rosen and Göran Lundborg created a new tool to test altered sensibility. They proposed a multisensory treatment (auditive and somatosensory sense) and published their papers as sensory relearning. Somatosensory testing is simultaneously testing and rehabilitation.
Claude J. Spicher proposed, in 2006, the concept of somatosensory rehabilitation. As the somatosensory system is considered as the centre of one of the etiologies of neuropathic pain Spicher proposed to switch the concept, in the French version of WIKIPEDIA :fr:Rééducation sensitive de la douleur the concept of Somatosensory Rehabilitation into Somatosensory Rehabilitation of Pain.
Somatosensory rehabilitation of neuropathic pain
Somatosensory rehabilitation of neuropathic pain is based on the assessment and reduction of hypoaesthesia. It is presented by the means of its paradigm; Look for tactile hypoesthesia, because, by decreasing hypoesthesia neuropathic pain decreases. Consequently, daily skin stimulations aim to supply axonal lesions.
In a 2016 report based on a study of 17 burn patients, Nedelec et. al. describe the method as follows: The treatment consisted of avoiding all touch in the allodynic zone while concurrently providing proximal sensory and vibratory counter stimulation. Once the mechanical allodynia was eliminated, the underlying hypoesthesia was treated...The sensory reeducation treatment for hypoesthesia consisted of touch discrimination, texture perception, and vibratory stimulation.
In some cases, the hypoaesthetic territory may be covered by an area of the skin that is painful to touch, and is therefore not accessible. Since 1979, this stimulus-induced pain is to be called allodynia in medicine. The original definition comes from Merksey and Bogduk (1994) “pain due to a stimulus which does not normally provoke pain”. In such situations, while performing the diagnostic testing of axonal lesions at the first occupational or physical therapy session, the two-point discrimination test becomes impossible, as it induces pain.
The presence of mechanical allodynia, may hinder other physical treatments. According to one retrospective study of Complex Regional Pain Syndrome (CRPS) patients with allodynia, the Somatosensory Rehabilitation Method was a good alternative to treat allodynia, regardless of how long the patient has been suffering from a CRPS condition..
Keywords
Allodynia - Distant Vibrotactile Counter Stimulation - Pressure Perception Threshold - McGill Pain Questionnaire - Neuropathic pain

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