Chronic non-freezing cold injury results in neuropathic pain due to a sensory neuropathy

Tom A. Vale, Mkael Symmonds, Michael J Polydefkis, Kelly Byrnes, Andrew S.C. Rice, Andreas C. Themistocleous, David L.H. Bennett

Research output: Contribution to journalArticle

Abstract

Non-freezing cold injury develops after sustained exposure to cold temperatures, resulting in tissue cooling but not freezing. This can result in persistent sensory disturbance of the hands and feet including numbness, paraesthesia and chronic pain. Both vascular and neurological aetiologies of this pain have been suggested but remain unproven. We prospectively approached patients referred for clinical assessment of chronic pain following non-freezing cold injury between 12 February 2014 and 30 November 2016. Of 47 patients approached, 42 consented to undergo detailed neurological evaluations including: questionnaires to detail pain location and characteristics, structured neurological examination, quantitative sensory testing, nerve conduction studies and skin biopsy for intraepidermal nerve fibre assessment. Of the 42 study participants, all had experienced non-freezing cold injury while serving in the UK armed services and the majority were of African descent (76.2%) and male (95.2%). Many participants reported multiple exposures to cold. The median time between initial injury and referral was 3.72 years. Pain was principally localized to the hands and the feet, neuropathic in nature and in all study participants associated with cold hypersensitivity. Clinical examination and quantitative sensory testing were consistent with a sensory neuropathy. In all cases, large fibre nerve conduction studies were normal. The intraepidermal nerve fibre density was markedly reduced with 90.5% of participants having a count at or below the 0.05 centile of published normative controls. Using the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain grading for neuropathic pain, 100% had probable and 95.2% definite neuropathic pain. Chronic nonfreezing cold injury is a disabling neuropathic pain disorder due to a sensory neuropathy. Why some individuals develop an acute painful sensory neuropathy on sustained cold exposure is not yet known, but individuals of African descent appear vulnerable. Screening tools, such as the DN4 questionnaire, and treatment algorithms for neuropathic pain should now be used in the management of these patients.

Original languageEnglish (US)
Pages (from-to)2557-2569
Number of pages13
JournalBrain
Volume140
Issue number10
DOIs
StatePublished - 2017

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Neuralgia
Neural Conduction
Nerve Fibers
Pain
Chronic Pain
Foot
Hand
Somatoform Disorders
Hypesthesia
Paresthesia
Neurologic Examination
Freezing
Blood Vessels
Referral and Consultation
Biopsy
Skin
Cold Injury
Wounds and Injuries
Surveys and Questionnaires
Therapeutics

Keywords

  • nerve conduction studies
  • neuropathic pain
  • peripheral nerve injury
  • sensory neuropathy
  • small fibre neuropathy

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Vale, T. A., Symmonds, M., Polydefkis, M. J., Byrnes, K., Rice, A. S. C., Themistocleous, A. C., & Bennett, D. L. H. (2017). Chronic non-freezing cold injury results in neuropathic pain due to a sensory neuropathy. Brain, 140(10), 2557-2569. https://doi.org/10.1093/brain/awx215

Chronic non-freezing cold injury results in neuropathic pain due to a sensory neuropathy. / Vale, Tom A.; Symmonds, Mkael; Polydefkis, Michael J; Byrnes, Kelly; Rice, Andrew S.C.; Themistocleous, Andreas C.; Bennett, David L.H.

In: Brain, Vol. 140, No. 10, 2017, p. 2557-2569.

Research output: Contribution to journalArticle

Vale, TA, Symmonds, M, Polydefkis, MJ, Byrnes, K, Rice, ASC, Themistocleous, AC & Bennett, DLH 2017, 'Chronic non-freezing cold injury results in neuropathic pain due to a sensory neuropathy', Brain, vol. 140, no. 10, pp. 2557-2569. https://doi.org/10.1093/brain/awx215
Vale, Tom A. ; Symmonds, Mkael ; Polydefkis, Michael J ; Byrnes, Kelly ; Rice, Andrew S.C. ; Themistocleous, Andreas C. ; Bennett, David L.H. / Chronic non-freezing cold injury results in neuropathic pain due to a sensory neuropathy. In: Brain. 2017 ; Vol. 140, No. 10. pp. 2557-2569.
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