Hyperalgesia

Patients of the Hyperalgesia feel slightly painful stimuli with a higher intensity. This reduction in the pain threshold is mediated either via the central or the peripheral nervous system. Therapy is carried out through conservative treatment steps such as pain therapy.

What is hyperalgesia?

Hyperalgesic patients react to hardly painful stimuli with an exaggerated reaction. Another person would also rate the stimuli as painful, but would perceive their intensity as significantly less than a patient with hyperalgesia.
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The pain threshold is a variable parameter and is therefore subject to fluctuations. As a result, people have different pain thresholds. The detection of pain is the task of the noziz receptors. These free nerve endings of the sensitive neurons from the spinal cord occur in all tissues that are considered to be sensitive to pain.

Noziz receptors detect surface pain, deep pain and pain in the organs. The variable sensitivity of the noci receptors explains the person-dependent pain threshold. The pain threshold corresponds to the stimulus threshold that brings the noci receptors to the formation of an action potential. This threshold is not only subject to fiber-dependent and individual fluctuations, but can also be pathologically changed in the context of various diseases.

By the term hyperalgesia, medicine refers to an excessive sensitivity to pain that results in an abnormally strong response to painful stimuli. Painful stimuli can be pressure, cold, warmth or inflammation. The hyperalgesia is assigned to the hyperesthesia and thus to the hypersensitivity to stimuli.

causes

Depending on the cause, hyperalgesia is divided into a primary and a secondary variant. Primary hyperalgesia is always present when the peripheral nervous system mediates the hypersensitivity. A secondary hyperalgesia, on the other hand, corresponds to a centrally mediated hypersensitivity and thus has the central nervous system as its basis.

Primary hyperalgesia leads to an excessive stimulus response by reducing the stimulus threshold for nociception in the peripheral nervous system. This form of hyperalgesia mainly includes hypersensitivity to cold and heat stimuli. Typically, secondary hyperalgesia manifests itself in the form of hypersensitivity to mechanical stimuli. Various diseases of the nervous system can be associated with hyperalgesia.

The most common primary cause of the pathological change in pain sensitivity is neuropathic pain syndrome after lesions of the nervous system. Basically, hyperalgesia is only a symptom and less a disease itself and can be associated with polyneuropathies, herpes zoster, Sudeck's disease, MS or a stroke, for example.

Hyperalgesic patients react to hardly painful stimuli with an exaggerated reaction. It is important here that the pain-inducing stimuli are generally painful stimuli. Another person would also rate the stimuli as painful, but would perceive their intensity as significantly less than a patient with hyperalgesia. In this context, allodynia must be distinguished from hyperalgesia.

Patients with allodynia, unlike those with hyperalgesia, suffer from pain sensations in response to a stimulus that is not in the slightest painful. For example, you may feel pain when you stroke a feather. This does not apply to patients with hyperalgesia. Depending on the cause of hyperalgesia, the symptom is associated with many other symptoms.

The type of pain sensation also depends on the primary cause. In neuropathic pain syndrome, for example, the pain shoots in like a fit and is usually described as dull.

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Diseases with this symptom

• Polyneuropathy
• Shingles

• Sudeck's disease
• Fibromyalgia

• multiple sclerosis
• stroke

Diagnosis & course of disease

The doctor receives the first indications of hyperalgesia from the medical history. A neurological examination is done to confirm the first suspicion. As part of the diagnosis, the affected areas of skin are lightly passed over, for example with a broken wooden stick. A patient with hyperalgesia complains of excessive pain.

In order to be able to assess the cause of the discomfort, imaging methods are mainly used. Lesions of the central nervous system and a neuropathic syndrome based on them can be cleared up, for example, by an MRI. The prognosis for patients with hyperalgesia depends on the primary cause of the sensory disorder.

Lesions in the central nervous system are prognostically less favorable than a peripherally mediated reduction of the pain threshold, since central nervous tissue may not regenerate.

Complications

Hyperalgesia, i.e. excessive sensitivity to pain, often results from a neuropathic pain syndrome. This refers to pain that occurs due to damage to the central or peripheral nervous system. This means that hyperalgesia is not in itself a disease, but a symptom.

One such example is shingles (herpes zoster). Various organs can be affected as complications, including, for example, the disease spreading to the brain (encephalitis) or the meninges (meningitis), but also to the eye and, in rare cases, the ear. In the worst cases it can even lead to paralysis.

Further diseases of a neuropathic pain syndrome are polyneuropathies, or diseases of the nerves, which can lead to [[diabetes mellitus diabetic foot, ie a reduced sensation on the foot and the risk for diabetics that it can lead to unnoticed wounds that can even lead to amputation can. Heart attacks can also occur that are not noticed because the sensitive nerves do not function properly.

Multiple sclerosis (MS) can also lead to hyperalgesia and characteristic complications can occur. The disease leads to muscle weakness and in later years to disability, which leads to the need for care, as well as urinary and fecal incontinence. In addition, there can be dementia, a change in personality and a reduced ability to learn.

When should you go to the doctor?

The extent to which someone with existing hyperalgesia needs to see a doctor depends, among other things, on his or her subjective feelings. Since hyperalgesia describes an above-average sensitivity to pain, those affected often suffer from it very much. This is because not only injuries or abuse trigger excessive pain, but also physical stimuli such as heat, cold and pressure.

Of course, people with hyperalgesia also suffer extremely from the usual pain associated with many diseases, which are generally considered uncomfortable but bearable.Hyperalgesia is not a disease in its own right, but a syndrome, mostly due to increased nervous sensitivity to pain.

For the treatment of hyperalgesia, the person affected is best placed in the hands of a neurologist. This will try to relieve the pain. In addition, he will give his patients tips on how to organize their everyday lives in order to limit the effects of hyperalgesia as much as possible. At the same time, however, the specialist will also clarify whether the hyperalgesia is not based on a serious disease that needs treatment, for example the nerves themselves.

If a patient affected by hyperalgesia is currently suffering acutely from a pain-related illness, such as the flu with a headache or a suppuration of the teeth, the treating internist or dentist is of course also asked, ideally in cooperation with the neurologist.

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Treatment & Therapy

The therapy for hyperalgesia depends on the cause. A peripheral mediated reduction in the pain threshold can be treated causally and may be curable. Pain therapy offers conservative treatment approaches. If the hyperalgesia is associated with a disturbed nerve cell metabolism, repeated nerve blocks with local anesthetics can occur.

A continuous variant in the form of implanted catheters is also an option. On the one hand, this interrupts the conduction of pain stimuli. On the other hand, vegetative nerves are blocked, so that blood pressure rises and the disturbed metabolism is improved. The implantation of continuously anesthetic catheters is carried out through a cannula. There are hardly any treatment options available for central nervous lesions as the origin of hyperalgesia.

In this case, treatment can only be symptomatic, as the causal lesion of the central nervous system cannot be reversed. The symptomatic therapy of a neuropathic pain syndrome therefore usually corresponds to a conservative pharmacological treatment that can encompass drug groups such as antidepressants, anticonvulsants, opioids and topicals such as lidocaine or capsaicin.

Experience has also shown that the body's pain threshold lowers as soon as a person experiences great pain. Hyperalgesic patients should of course not induce painful situations, but neither should they avoid them excessively.

Outlook & forecast

In hyperalgesia there is a strong reduction in the quality of life. Those affected feel even slight pain more intensely, which has a negative effect on everyday life. The hyperalgesia can be identified relatively easily by the doctor by applying a light stimulus to the skin. Those affected complain of severe pain, which in fact does not occur. With the help of an MRI, further examinations can be carried out with which the cause of the hyperalgesia can be identified.

Treatment can be done in a number of different ways and depends heavily on the cause of the hyperalgesia. In many cases, the stimuli can be limited by pain therapy. Catheters can also be used in those affected, which interrupt the conduction of pain and thereby alleviate the symptoms. In some cases, antidepressants are also used to reduce psychological pain.

Whether the treatment will be successful cannot generally be predicted. This also strongly depends on how long the patient has been complaining about the hyperalgesia and how far it has spread. Hyperalgesia can be avoided through a healthy lifestyle.

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prevention

Hyperalgesia is the symptom of damage to the central or peripheral nervous system. Hyperalgesia can only be prevented insofar as lesions of the central nervous system or peripheral lesions can be prevented. Since the symptom is associated with strokes, for example, preventive measures to avoid strokes are among the preventive steps.

You can do that yourself

Even slight pain is felt so strongly by the sick that their quality of life suffers significantly. As the diagnosis is not always easy, it is often not possible to help those affected quickly enough. A doctor cannot empathize with the pain of his patient and so only stimuli on the corresponding nerves help. Then it is possible to quickly determine the cause of the disease using an MRI. After a successful diagnosis, differentiated treatments, which also have different prognoses, must be considered.

Individual pain therapy often enables a symptom-free future. Another very useful therapy is to interrupt the transmission of pain. A catheter is used permanently, which permanently numbs the pain, alleviates the symptoms and significantly improves the quality of life. Antidepressants have the effect of reducing the psychological sensitivity to pain. Great success can also be achieved with this and the person affected can experience everyday life painlessly.

However, whether an improvement in quality of life can be achieved in each case cannot be foreseen in principle. As with many other diseases, an early diagnosis and no widespread spread of the disease are important for the success of the treatment of hyperalgesia. As general prevention, a generally healthy lifestyle is the best prerequisite.