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World J Clin Cases. Sep 16, 2013; 1(6): 197-201
Published online Sep 16, 2013. doi: 10.12998/wjcc.v1.i6.197
Published online Sep 16, 2013. doi: 10.12998/wjcc.v1.i6.197
Dynamic mechanical allodynia following finger amputation: Unexpected skin hyperinnervation
Michelangelo Buonocore, Unit of Clinical Neurophysiology and Neurodiagnostic Skin Biopsy, “Salvatore Maugeri” Foundation, Scientific Institute of Pavia, 27100 Pavia, Italy
Maria Concetta Gagliano, Unit of Hand Surgery and Microsurgery, Policlinico of Modena, 41124 Modena, Italy
Cesare Bonezzi, Unit of Pain Medicine, “Salvatore Maugeri” Foundation, Scientific Institute of Pavia, 27100 Pavia, Italy
Author contributions: Buonocore M performed the skin biopsies and wrote the paper; Gagliano MC performed surgical operation; Bonezzi C diagnosed and treated the patient after surgery.
Correspondence to: Michelangelo Buonocore, MD, Unit of Clinical Neurophysiology and Neurodiagnostic Skin Biopsy, “Salvatore Maugeri” Foundation, Scientific Institute of Pavia, Via Maugeri 10, 27100 Pavia, Italy. michelangelo.buonocore@fsm.it
Telephone: +39-0382-592392 Fax: +39-0382-592020
Received: June 14, 2013
Revised: August 8, 2013
Accepted: August 20, 2013
Published online: September 16, 2013
Revised: August 8, 2013
Accepted: August 20, 2013
Published online: September 16, 2013
Core Tip
Core tip: In some patients with post-amputation chronic pain dynamic mechanical allodynia (a painful sensation evoked by gentle stroking the skin) represents the most disabling problem. So far, little is known about the mechanism of this peculiar type of pain. We present here a patient who complained of severe dynamic mechanical allodynia in the hand after amputation of the left second finger. The neurodiagnostic skin biopsy showed an increased innervation of the allodynic skin compared to the contralateral, normal skin area (+ 80.1%), suggesting hyperinnervation as a possible pain mechanism. Interestingly, topical capsaicin (0.075%) relieved allodynia for a long period.