IS HEAT HYPOALGESIA A USEFUL PARAMETER IN QUANTITATIVE THERMAL TESTING OF ALCOHOLIC POLYNEUROPATHY

Detection of thermal hypoaesthesia, hyperalgesia, and paradoxical sens ation significantly contribute to the diagnosis of polyneuropathy (PNP ). There is controversy about the clinical usefulness of detected heat hypoalgesia. In 50 chronic alcoholic patients we compared the prevale nce and diagnostic value of heat hypoalgesia (HPT) to that of cold (CT ) and warm (WT) hypoaesthesia using a ''Marstock'' thermotest. Clinica l examination revealed PNP in 56%, cold hypoaesthesia was present in 6 2%, warm hypoaesthesia in 24%, paradoxical thermal sensation in 10%, c old and heat hyperalgesia in 12%, and heat hypoalgesia in 22%. Only 1 patient(2%) presented with heat hypoalgesia but normal warm and cold t hresholds; he reported paradoxical thermal sensation and had PNP. One patient suffered first degree burn injury from heat pain examination. Heat hypoalgesia contributed least to the diagnosis of polyneuropathy (HPT versus CT: P < 0.001). In patients with sensory loss, testing hea t hypoalgesia bears some risk of burn injury. In contrast to thermal h ypoaesthesia and hyperalgesia, it does not significantly enrich the di agnostic workup of alcoholic polyneuropathies. (C) 1994 John Wiley & S ons, Inc.