Evaluation of nociceptive Aδ- and C-fiber dysfunction with lidocaine using intraepidermal electrical stimulation

Objective: To investigate whether intraepidermal electrical stimulation (IES) can evaluate nociceptive A delta- and C-fiber dysfunctions of an experimental model of small-fiber neuropathy (SFN) with transdermal lidocaine. Methods: Lidocaine tape or placebo was applied to the dorsum of the feet in 14 healthy subjects. Reaction time (RT), sensory threshold, and evoked potentials (EPs) were measured using IES before, and 30 and 60 min after lidocaine/placebo application. Results: All subjects felt pricking sensations following A delta- fiber stimulation, and light painful sensations such as pricking, tingling, or burning following C-fiber stimulation using IES. RT was divided bimodally between A delta- and C-fiber stimulations. At 30 min, lidocaine increased the sensory threshold and decreased the amplitude of EPs in both fiber stimulations. At 60 min, lidocaine's effects were greater for C fibers than for A delta fibers. The sensory threshold and amplitude of EPs were unchanged among placebo sessions. Conclusions: IES demonstrated differential effects of transdermal lidocaine on nociceptive A delta and C fibers, and elucidated the pathophysiology of the experimental model of SFN. Significance: IES has advantages in terms of cost, convenience, and invasiveness. It may have potential for a clinical tool to elucidate the pathophysiology of patients with SFN, including the differences between A delta and C fibers. (C) 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved