Dysfunction in Multiple Primary Afferent Fiber Subtypes Revealed By Quantitative Sensory Testing in Patients with Chronic Vincristine-Induced Pain  Patrick M. Dougherty, PhD, Juan P. Cata, MD, Allen W. Burton, MD, Khanh Vu, MD, Han-Rong Weng, MD, PhD  Journal of Pain and Symptom Management  Volume 33, Issue 2, Pages 166-179 (February 2007) DOI: 10.1016/j.jpainsymman.2006.08.006 Copyright © 2007 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 1 A representative pain diagram completed by a patient with vincristine-induced neuropathic pain. The darkly shaded areas show where the patient complained of ongoing pain. This area was described as “burning” and “needles.” The lightly shaded area shows the border area of altered sensibility. This area was described as “numb” and “cold.” A typically sharp boundary between the areas affected and “normal” skin was indicated by the lack of drawing above the wrists, though this patient did draw an unusual extension of the border area up the legs. Journal of Pain and Symptom Management 2007 33, 166-179DOI: (10.1016/j.jpainsymman.2006.08.006) Copyright © 2007 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 2 The bar graph shows the incidence at which each word on the descriptor list was chosen by the patients (n=18) to describe their area of ongoing pain. Patients on average chose 5.2±3.0 words, but all chose the word “numb,” followed by others at deceasing frequency. Journal of Pain and Symptom Management 2007 33, 166-179DOI: (10.1016/j.jpainsymman.2006.08.006) Copyright © 2007 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 3 The bar graphs show the touch detection (left side) and slotted pegboard time (right side) data. Patients (filled bars, n=18) showed significantly elevated touch threshold throughout all areas tested (panel A) and significantly elevated slotted pegboard time (panel B) compared to controls (open bars, n=32). ***P<0.001. Journal of Pain and Symptom Management 2007 33, 166-179DOI: (10.1016/j.jpainsymman.2006.08.006) Copyright © 2007 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 4 The bar graphs summarize the 50% sharpness detection threshold. The pair of bars at the left shows that the patients (filled bar, n=16) had a significantly elevated sharpness detection threshold in their area of ongoing pain (fingertips) compared to the control subjects (n=32, open bar). There was a trend for the patients to show increased sharpness detection threshold in the remaining test sites, but these were not significantly different from control subjects. *P<0.05. Journal of Pain and Symptom Management 2007 33, 166-179DOI: (10.1016/j.jpainsymman.2006.08.006) Copyright © 2007 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 5 The bar graphs on the left side of the figure summarize the mean baseline skin temperatures in the test sites in the patients (n=12) compared to the control subjects (n=32), whereas the pair of bars on the right shows the mean ratio of skin temperature between the fingertips and volar skin for each group. The skin in all three test sites was cooler in the patients (filled bars) than in the control subjects (open bars), but this difference was significant only for the pain area (fingertips). The mean ratio of skin temperature between the fingertips and volar skin was also significantly different between the two groups. *P<0.05. Journal of Pain and Symptom Management 2007 33, 166-179DOI: (10.1016/j.jpainsymman.2006.08.006) Copyright © 2007 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 6 The bar graphs show the thermal detection data in the chemotherapy patients (filled bars, n=12) compared to the normal volunteers (open bars) with upward going set at the top of the figure showing the warm and heat-pain data and the downward going set of bars at the bottom showing the cool and cold pain data. The warm detection thresholds were elevated throughout all test sites (upper set), but the heat-pain thresholds were not significantly changed. There were no differences in the thresholds for cool detection between the groups. However, the chemotherapy patients showed a marked difference in cold detection threshold in the normal area. The data shown for cold pain threshold in the control subjects represents the default value for cold pain because no control subjects reported pain over the temperature/duration range that was tested. The patient commonly reported paradoxical burning to skin cooling at significantly higher temperatures. *P<0.05. Journal of Pain and Symptom Management 2007 33, 166-179DOI: (10.1016/j.jpainsymman.2006.08.006) Copyright © 2007 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 7 The 3D plot shows the relationship of changes in touch (x-axis), sharpness (y-axis), and warm percepts (z-axis) for the pain area in the chemotherapy patients. The touch scale shows the number of von Frey filaments the patients touch threshold was shifted from the expected value defined in the control subjects to a cutoff of 3. Similarly, the sharpness scale is based on the number of weighted probes the patients' threshold was altered from that expected from the control population. The warm percept scale is based on the number of standard deviations that the patient thresholds were shifted from the population norm. Journal of Pain and Symptom Management 2007 33, 166-179DOI: (10.1016/j.jpainsymman.2006.08.006) Copyright © 2007 U.S. Cancer Pain Relief Committee Terms and Conditions