TACTILE, THERMAL AND PAIN SENSIBILITY IN BURNED PATIENTS WITH AND WITHOUT CHRONIC PLAIN AND PARESTHESIA PROBLEMS

Abnormal return of cutaneous sensibility is common after burn injuries and many patients complain of painful and/or paresthetic sensations i n their healed wounds. However, little is known about the exact nature and severity of these problems. The present study was designed to pro vide a quantitative evaluation of the cutaneous sensibility in burned patients. Tactile, thermal and pain thresholds were measured in 121 pa tients with healed burns paired-matched to 121 control healthy subject s more than 18 months after the burns. Testing was confined to both up per limbs and was performed in a healed burn area and its contralatera l burned or unburned counterpart. The tested sites were also divided i nto symptomatic and asymptomatic ones, depending on the presence or no t of pain or paresthesia at the site. The results showed significantly higher sensory thresholds in burned patients than control subjects. S everity of the deficits of the various sensory modalities was, however , a function of burn depth. Deep burn injuries which had required skin grafts to heal were more seriously affected than superficial burns wh ich had healed spontaneously. Significant sensory losses were found no t only in burn sites but also in the noninjured areas suggesting chang es in the central nervous system. when symptomatic and asymptomatic si tes were compared, significant deficits were observed in the tactile m odality (touch-pressure). Other significant predictors of chronic sens ory problems were burn depth and patients' age. Pathophysiological mec hanisms of diminished sensibility in burned and unburned skin as long as several years after the injury are discussed along with those impli cated in pain and paresthesia problems reported by the patients. (C) 1 998 International Association for the Study of Pain. Published by Else vier Science B.V.