J Clin Neurol.  2019 Oct;15(4):480-487. 10.3988/jcn.2019.15.4.480.

‘Sirim’ (Cold) Pain as a Common Symptom in Korean Patients with Clinically Suspected Small-Fiber Neuropathy

• Cho EB
• Seok JM
• Min JH
• Suh BC
• Park KJ
• Kim BJ

• KMID: 2467757
• DOI: http://doi.org/10.3988/jcn.2019.15.4.480

Abstract

BACKGROUND AND PURPOSE
Diagnosing small-fiber neuropathy (SFN) is challenging because there is no gold-standard test and few diagnostic tests. This study investigated the clinical symptom profile and its associations with the results of quantitative sensory testing (QST) and the quantitative sudomotor axon reflex test (QSART) as well as the quality of life (QOL) in patients with clinically suspected SFN.
METHODS
This study involved 63 patients with clinically suspected length-dependent SFN. Assessments were performed using QST, QSART, SFN Symptoms Inventory Questionnaire, Neuropathic Pain Symptom Inventory, "˜Sirim' frequency and "˜Sirim' (cold) pain severity, and 36-item Short-Form Health Survey. Multiple logistic and linear regression analyses were performed to predict risk factors for QST or QSART abnormalities and QOL, respectively.
RESULTS
"˜Sirim' and "˜Sirim' pain was the most-common (84%) and the most-severe complaint (mean score of 6.3 on a numerical rating scale ranging from 0 to 10) in patients with clinically suspected SFN. The findings of QST [cold detection threshold (CDT)] and QSART were abnormal in 71% (n=45/57) and 62% (n=39/56) of the patients, respectively. An abnormal CDT was correlated with more-severe stabbing pain (odds ratio=2.23, 95% CI=1.02-4.87, p=0.045). Restless-leg symptoms (β=−7.077) and pressure-evoked pain (β=−5.034) were independent predictors of the physical aspects of QOL.
CONCLUSIONS
"˜Sirim' pain, similar to cold pain, should be considered a major neuropathic pain in SFN. Among pain characteristics, stabbing pain of a spontaneous paroxysmal nature may be more pronounced in the setting of dysfunctional Aδ fibers with functional autonomic C fibers.

Keyword

small fiber neuropathy; sensory; autonomic; cold; pain; quality of life

MeSH Terms

Axons
Diagnostic Tests, Routine
Erythromelalgia
Health Surveys
Humans
Linear Models
Nerve Fibers, Unmyelinated
Neuralgia
Quality of Life
Reflex
Risk Factors

Figure

• 

  Fig. 1 Flow chart of the selection process to enroll eligible patients. The numbers of finally included patients with abnormal results either for QST (CDT) or QSART are in boldface. CDT: cold detection threshold, NCS: nerve conduction test, QSART: quantitative sudomotor axon reflex test, QST: quantitative sensory testing, SFN: small-fiber neuropathy.

• 

  Fig. 2 Small-Fiber Neuropathy Symptom Inventory Questionnaire plus ‘Sirim’ findings. The symptoms are listed in order from the most to the least frequent based on the sum of ‘often’ and ‘always’ frequencies.

• 

  Fig. 3 Neuropathic Pain Symptom InventoryI plus ‘Sirim’ (cold) pain findings. A numerical rating scale ranging from 0 to 10 was used to score pain intensity.

• 

  Fig. 4 Correlations among SFN-SIQ plus ‘Sirim’ pain (A) and NPSI plus ‘Sirim’ pain (B). Correlations were considered to be significant (and are indicated by blue circles) for Spearman's rho (ρ)>0.3 and p<0.01. NPSI: Neuropathic Pain Symptom Inventory, SFN-SIQ: Small-Fiber Neuropathy Symptoms Inventory Questionnaire.

• 

  Fig. 5 Comparison of pain profiles among patients with different CDT and QSART results. The group with only abnormal CDT findings had more-severe stabbing pain compared to the group with both abnormal CDT and abnormal QSART findings in multiple logistic regression analysis after controlling for age, sex, and disease duration. A: burning pain, B: squeezing pain, C: pressure pain, CDT: cold detection threshold, D: stabbing pain (*), E: electric-shock-like pain, F: brush-evoked pain, G: pressure-evoked pain, H: cold-evoked pain, I: pins-and-needles sensation, J: tingling sensation, K: ‘Sirim’ pain, NRS: numerical rating scale, QSART: quantitative sudomotor axon reflex test.

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