Correlation of the neuropathic pain and electrodiagnostic tests in earthquake-related peripheral nerve injuries
Abstract
Aim: Peripheral nerve injury resulting from being buried under earthquake-related debris can lead to neuropathic pain. This study investigates the relationship between neuropathic pain and electrodiagnostic test findings in patients with peripheral nerve lesions caused by entrapment under debris.
Materials and Methods: This retrospective study included patients who developed peripheral nerve lesions due to entrapment under debris during the Kahramanmaraş-centered earthquakes in February 2023. Abnormalities in compound nerve action potentials (CNAPs) and compound muscle action potentials (CMAPs) were categorized as mild, moderate, or severe.
Results: 62 (34 female, 28 male) patients were included in this study. The mean (min-max) disease duration, time under debris, and Douleur Neuropathique 4 Questions (DN4) scores were 59.4 ± 37.1 (21-180) days, 22.6 ± 29.7 (0.5-130) hours, and 4.9 ± 1.7 (1-9), respectively.
A positive correlation was observed between the number of severe CNAP/CMAP abnormalities and DN4 scores (p=0.024, r=0.287/ p=0.003, r=0.371). Patients with severe CMAP abnormalities in at least one or at least two nerves had higher DN4 scores compared to those without (p=0.039/p=0.009).
Conclusion: This study highlights a relationship between neuropathic pain and severe CNAP/CMAP abnormalities in patients with peripheral nerve lesions due to entrapment under debris.
References
- Hanewinckel R, Ikram MA, Van Doorn PA. Peripheral neuropathies. Handb Clin Neurol. 2016;138:263-82.
- Rubin DI. Brachial and lumbosacral plexopathies: A review. Clin Neurophysiol Pract. 2020;5:173-93.
- Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25(2):387-405.
- MacKenzie JS, Banskota B, Sirisreetreerux N, Shafiq B, Hasenboehler EA. A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries. World J Emerg Surg. 2017;12:9.
- Pripotnev S, Bucelli RC, Patterson JMM, Yee A, Pet MA, Mackinnon S. Interpreting Electrodiagnostic Studies for the Management of Nerve Injury. J Hand Surg Am. 2022;47(9):881-9.
- Stålberg E, van Dijk H, Falck B, Kimura J, Neuwirth C, Pitt M, et al. Standards for quantification of EMG and neurography. Clin Neurophysiol. 2019;130(9):1688-729.
- Zangiabadi N, Ahrari MN. Electro-diagnostic and Clinical Changes of Peripheral Neuropathies in Bam Earthquake Victims. American Journal of Environmental Sciences. 2005;1(3).
- He CQ, Zhang LH, Liu XF, Tang PF. A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan, China. Neural Regen Res. 2015;10(2):252-9.
- Kuwagata Y, Oda J, Tanaka H, Iwai A, Matsuoka T, Takaoka M, et al. Analysis of 2,702 traumatized patients in the 1995 Hanshin-Awaji earthquake. J Trauma. 1997;43(3):427-32.
- Cammack F, Shipton EA. The christchurch earthquake: crush injury, neuropathic pain, and posttraumatic stress disorder. Case Rep Med. 2013;2013:973234.
- Walsh J, Rabey MI, Hall TM. Agreement and correlation between the self-report leeds assessment of neuropathic symptoms and signs and Douleur Neuropathique 4 Questions neuropathic pain screening tools in subjects with low back-related leg pain. J Manipulative Physiol Ther. 2012;35(3):196-202.
- Aydemir O. Validity and Reliability of Turkish Version of Hospital Anxiety and Depression Scale. Turkish Journal of Psychiatry. 1997;8:280-7.
- Chen S, Andary M, Buschbacher R, Del Toro D, Smith B, So Y, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve. 2016;54(3):371-7.
- Fidancı H, Öztürk I, Köylüoğlu A, Yildiz M, Buturak Ş, Arlier Z. The needle electromyography findings in the neurophysiological classification of ulnar neuropathy at the elbow. Turkish journal of medical sciences. 2020;50.
- Fidancı H, Öztürk İ, Köylüoğlu A, Yıldız M, Arlier Z. Bilateral Nerve Conduction Studies Must Be Considered in the Diagnosis of Sciatic Nerve Injury Due to Intramuscular Injection. Neurological Sciences and Neurophysiology. 2020;37:94.
- FİDANCI UDH, ÖZTÜRK UDİ. Ekstremitelerin Tuzak ve Kompresyon Mononöropatileri: Akademisyen Kitabevi; 2020.
- Yuen EC, So YT, Olney RK. The electrophysiologic features of sciatic neuropathy in 100 patients. Muscle Nerve. 1995;18(4):414-20.
- Devor M. Neuropathic pain and injured nerve: peripheral mechanisms. Br Med Bull. 1991;47(3):619-30.
- Kerstman E, Ahn S, Battu S, Tariq S, Grabois M. Neuropathic pain. Handb Clin Neurol. 2013;110:175-87. Bridges D, Thompson SW, Rice AS. Mechanisms of neuropathic pain. Br J Anaesth. 2001;87(1):12-26.
- Ramer MS, French GD, Bisby MA. Wallerian degeneration is required for both neuropathic pain and sympathetic sprouting into the DRG. Pain. 1997;72(1-2):71-8.
- Borich MR, Brodie SM, Gray WA, Ionta S, Boyd LA. Understanding the role of the primary somatosensory cortex: Opportunities for rehabilitation. Neuropsychologia. 2015;79(Pt B):246-55.
- Turco CV, El-Sayes J, Savoie MJ, Fassett HJ, Locke MB, Nelson AJ. Short- and long-latency afferent inhibition; uses, mechanisms and influencing factors. Brain Stimul. 2018;11(1):59-74.
- Drees C, Wilbourn AJ, Stevens GH. Main trunk tibial neuropathies. Neurology. 2002;59(7):1082-4.
- Yoshida T, Tada K, Uemura K, Yonenobu K. Peripheral nerve palsies in victims of the Hanshin-Awaji earthquake. Clin Orthop Relat Res. 1999(362):208-17.
- Sarisözen B, Durak K. Extremity injuries in children resulting from the 1999 Marmara earthquake: an epidemiologic study. J Pediatr Orthop B. 2003;12(4):288-91.
- Landau ME, Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am. 2013;24(1):49-66.
- Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther. 2005;28(5):345.
- Bowley MP, Doughty CT. Entrapment Neuropathies of the Lower Extremity. Med Clin North Am. 2019;103(2):371-82.
- Bergquist ER, Hammert WC. Timing and appropriate use of electrodiagnostic studies. Hand Clin. 2013;29(3):363-70.
Depremle ilişkili periferik sinir yaralanmalarında nöropatik ağrı ile elektrodiyagnostik testlerin korelasyonu
Abstract
Amaç: Depremle ilişkili enkaz altında kalmaya bağlı gelişen periferik sinir yaralanmaları nöropatik ağrıya yol açabilir. Bu çalışma, enkaz altında kalma sonucu periferik sinir hasarı olan hastalarda nöropatik ağrı ile elektrodiyagnostik test bulguları arasındaki ilişkiyi araştırmaktadır.
Gereç ve Yöntem: Bu retrospektif çalışma, Şubat 2023'te Kahramanmaraş merkezli depremler sırasında enkaz altında kalma sonucu oluşan periferik sinir hasarı gelişen hastaları içermektedir. Bileşik sinir aksiyon potansiyelleri (CNAP) ve bileşik kas aksiyon potansiyellerindeki (CMAP) anormallikler hafif, orta veya şiddetli olarak kategorize edilmiştir.
Bulgular: Bu çalışmaya 62 (34 kadın, 28 erkek) hasta dahil edilmiştir. Ortalama (min-maks) hastalık süresi, enkaz altında kalma süresi ve DN4 skorları sırasıyla 59,4 ± 37,1 (21-180) gün, 22,6 ± 29,7 (0,5-130) saat ve 4,9 ± 1,7 (1-9) olarak bulunmuştur. Şiddetli CNAP/CMAP anormalliklerinin sayısı ile DN4 skorları arasında pozitif bir korelasyon gözlenmiştir (p=0,024, r=0,287 / p=0,003, r=0,371). En az bir veya en az iki sinirde şiddetli CMAP anormallikleri olan hastalar, anormallik bulunmayan hastalara göre daha yüksek DN4 skorlarına sahipti (p=0,039 / p=0,009).
Sonuç: Bu çalışma, enkaz altında kalmaya bağlı periferik sinir hasarı olan hastalarda nöropatik ağrı ile şiddetli CNAP/CMAP anormallikleri arasındaki ilişkiye dikkat çekmektedir.
References
- Hanewinckel R, Ikram MA, Van Doorn PA. Peripheral neuropathies. Handb Clin Neurol. 2016;138:263-82.
- Rubin DI. Brachial and lumbosacral plexopathies: A review. Clin Neurophysiol Pract. 2020;5:173-93.
- Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25(2):387-405.
- MacKenzie JS, Banskota B, Sirisreetreerux N, Shafiq B, Hasenboehler EA. A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries. World J Emerg Surg. 2017;12:9.
- Pripotnev S, Bucelli RC, Patterson JMM, Yee A, Pet MA, Mackinnon S. Interpreting Electrodiagnostic Studies for the Management of Nerve Injury. J Hand Surg Am. 2022;47(9):881-9.
- Stålberg E, van Dijk H, Falck B, Kimura J, Neuwirth C, Pitt M, et al. Standards for quantification of EMG and neurography. Clin Neurophysiol. 2019;130(9):1688-729.
- Zangiabadi N, Ahrari MN. Electro-diagnostic and Clinical Changes of Peripheral Neuropathies in Bam Earthquake Victims. American Journal of Environmental Sciences. 2005;1(3).
- He CQ, Zhang LH, Liu XF, Tang PF. A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan, China. Neural Regen Res. 2015;10(2):252-9.
- Kuwagata Y, Oda J, Tanaka H, Iwai A, Matsuoka T, Takaoka M, et al. Analysis of 2,702 traumatized patients in the 1995 Hanshin-Awaji earthquake. J Trauma. 1997;43(3):427-32.
- Cammack F, Shipton EA. The christchurch earthquake: crush injury, neuropathic pain, and posttraumatic stress disorder. Case Rep Med. 2013;2013:973234.
- Walsh J, Rabey MI, Hall TM. Agreement and correlation between the self-report leeds assessment of neuropathic symptoms and signs and Douleur Neuropathique 4 Questions neuropathic pain screening tools in subjects with low back-related leg pain. J Manipulative Physiol Ther. 2012;35(3):196-202.
- Aydemir O. Validity and Reliability of Turkish Version of Hospital Anxiety and Depression Scale. Turkish Journal of Psychiatry. 1997;8:280-7.
- Chen S, Andary M, Buschbacher R, Del Toro D, Smith B, So Y, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve. 2016;54(3):371-7.
- Fidancı H, Öztürk I, Köylüoğlu A, Yildiz M, Buturak Ş, Arlier Z. The needle electromyography findings in the neurophysiological classification of ulnar neuropathy at the elbow. Turkish journal of medical sciences. 2020;50.
- Fidancı H, Öztürk İ, Köylüoğlu A, Yıldız M, Arlier Z. Bilateral Nerve Conduction Studies Must Be Considered in the Diagnosis of Sciatic Nerve Injury Due to Intramuscular Injection. Neurological Sciences and Neurophysiology. 2020;37:94.
- FİDANCI UDH, ÖZTÜRK UDİ. Ekstremitelerin Tuzak ve Kompresyon Mononöropatileri: Akademisyen Kitabevi; 2020.
- Yuen EC, So YT, Olney RK. The electrophysiologic features of sciatic neuropathy in 100 patients. Muscle Nerve. 1995;18(4):414-20.
- Devor M. Neuropathic pain and injured nerve: peripheral mechanisms. Br Med Bull. 1991;47(3):619-30.
- Kerstman E, Ahn S, Battu S, Tariq S, Grabois M. Neuropathic pain. Handb Clin Neurol. 2013;110:175-87. Bridges D, Thompson SW, Rice AS. Mechanisms of neuropathic pain. Br J Anaesth. 2001;87(1):12-26.
- Ramer MS, French GD, Bisby MA. Wallerian degeneration is required for both neuropathic pain and sympathetic sprouting into the DRG. Pain. 1997;72(1-2):71-8.
- Borich MR, Brodie SM, Gray WA, Ionta S, Boyd LA. Understanding the role of the primary somatosensory cortex: Opportunities for rehabilitation. Neuropsychologia. 2015;79(Pt B):246-55.
- Turco CV, El-Sayes J, Savoie MJ, Fassett HJ, Locke MB, Nelson AJ. Short- and long-latency afferent inhibition; uses, mechanisms and influencing factors. Brain Stimul. 2018;11(1):59-74.
- Drees C, Wilbourn AJ, Stevens GH. Main trunk tibial neuropathies. Neurology. 2002;59(7):1082-4.
- Yoshida T, Tada K, Uemura K, Yonenobu K. Peripheral nerve palsies in victims of the Hanshin-Awaji earthquake. Clin Orthop Relat Res. 1999(362):208-17.
- Sarisözen B, Durak K. Extremity injuries in children resulting from the 1999 Marmara earthquake: an epidemiologic study. J Pediatr Orthop B. 2003;12(4):288-91.
- Landau ME, Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am. 2013;24(1):49-66.
- Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther. 2005;28(5):345.
- Bowley MP, Doughty CT. Entrapment Neuropathies of the Lower Extremity. Med Clin North Am. 2019;103(2):371-82.
- Bergquist ER, Hammert WC. Timing and appropriate use of electrodiagnostic studies. Hand Clin. 2013;29(3):363-70.
Details
| Primary Language | English |
|---|---|
| Subjects | Neurology and Neuromuscular Diseases |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 10, 2025 |
| Submission Date | November 13, 2024 |
| Acceptance Date | January 16, 2025 |
| Published in Issue | Year 2025Volume: 64 Issue: 2 |
