Allodynia: When Touch Causes Pain and What to Do

Pain upon touch (tactile allodynia)

Hello, doctor.
I have a problem that has been bothering me for a long time, but I don't know which specialist to consult.
Sometimes, certain areas of my body (arms, abdomen, lower back, thighs, and calves) suddenly become very painful when touched.
Even gentle pressure or movement in a vehicle can cause pain.
When I'm not experiencing these episodes, I feel fine, but once the pain starts, it can last for one to two days.
Could this be related to autonomic nervous system issues? What kind of tests should I consider? Since I haven't had an episode recently, would it be possible to identify the cause if I get tested when I'm not experiencing pain? Thank you.

Miss Lin, 20~29 year old female. Ask Date: 2020/06/27

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it seems less likely to be an autonomic nervous system issue.
Generally, the autonomic nervous system is regulated by the sympathetic and parasympathetic nervous systems, where one acts as the accelerator and the other as the brake.
The sympathetic nervous system is responsible for stimulating the "gas pedal," driving the body into action, while the parasympathetic nervous system is responsible for applying the "brake," allowing the body to rest.
For example, during exercise, the sympathetic nervous system is activated, leading to increased heart rate, faster breathing, and increased sweating.
Once the exercise stops, the parasympathetic nervous system takes over, slowing the heart rate, decreasing the breathing rate, and reducing sweating.
Your neurological symptoms are more likely indicative of peripheral nerve issues, such as spinal nerve root compression.
It is advisable to consult a neurologist to discuss potential examinations and treatments.
It would be helpful to keep a detailed record of your neurological symptoms for the physician's reference.
Wishing you good health, peace, and joy.
Dr.
Jiang from Taoyuan Hospital cares about you.

Reply Date: 2020/06/27

More Info

Allodynia is a condition where normally non-painful stimuli, such as light touch or pressure, cause pain. This phenomenon can be perplexing and distressing, as it disrupts daily life and can lead to significant discomfort. Understanding the underlying causes and potential treatments for allodynia is crucial for managing this condition effectively.

Possible Causes of Allodynia
1. Nerve Damage or Dysfunction: One of the most common causes of allodynia is nerve damage, which can occur due to various conditions such as diabetes, shingles (postherpetic neuralgia), or traumatic injuries. When nerves are damaged, they may send abnormal signals to the brain, interpreting non-painful stimuli as painful.

2. Central Sensitization: This is a condition where the central nervous system becomes sensitized to stimuli, leading to an exaggerated response to pain. Conditions such as fibromyalgia, chronic fatigue syndrome, and other chronic pain syndromes often involve central sensitization.

3. Inflammation: Inflammatory conditions, such as arthritis or other autoimmune diseases, can lead to increased sensitivity in the affected areas, resulting in allodynia.

4. Psychological Factors: Stress, anxiety, and depression can also play a role in how pain is perceived. Psychological factors can amplify the sensation of pain, making allodynia more pronounced.

Diagnostic Approach
If you are experiencing episodes of allodynia, it is essential to consult a healthcare professional who specializes in pain management or neurology. Here are some steps you can take:
1. Keep a Pain Diary: Documenting when the pain occurs, its intensity, duration, and any associated activities or triggers can provide valuable information to your healthcare provider.

2. Consult a Specialist: A neurologist or pain management specialist can evaluate your symptoms and medical history. They may perform a physical examination and recommend specific tests, such as nerve conduction studies or imaging, to assess for underlying conditions.

3. Consider Psychological Evaluation: If psychological factors are suspected to contribute to your pain, a mental health professional can help assess and address these issues.

Treatment Options
Treatment for allodynia often involves a multidisciplinary approach:
1. Medications: Various medications can be effective in managing allodynia. These may include:
- Antidepressants: Certain types, such as tricyclic antidepressants (e.g., amitriptyline), can help modulate pain perception.

- Anticonvulsants: Medications like gabapentin or pregabalin are often used to treat nerve pain.

- Topical Treatments: Lidocaine patches or capsaicin cream can provide localized pain relief.

2. Physical Therapy: Engaging in physical therapy can help improve function and reduce pain. A physical therapist can design a program tailored to your needs, focusing on strengthening and flexibility.

3. Cognitive Behavioral Therapy (CBT): This type of therapy can help address the psychological aspects of chronic pain, teaching coping strategies and pain management techniques.

4. Lifestyle Modifications: Stress management techniques, regular exercise, and a healthy diet can also play a role in managing pain and improving overall well-being.

Conclusion
Allodynia can be a challenging condition, but understanding its potential causes and treatment options is the first step toward finding relief. If you experience episodes of pain triggered by touch, it is crucial to seek medical advice to identify the underlying cause and develop an appropriate treatment plan. While it may be difficult to diagnose the condition during asymptomatic periods, a thorough evaluation can still provide insights into your health and guide future management strategies. Remember, you are not alone in this, and there are healthcare professionals who can help you navigate these challenges.

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