Figure 3.

This provides an example of how detailed phenotyping and application of the NeupSIG grading system was applied to non-freezing cold injury. Non-freezing cold injury arises following exposure to a cold wet environment, most commonly in army service personnel. This condition is associated with disabling chronic pain but the basis of this pain remained mysterious. All study participants gave a history of exposure to a cold wet environment with acute onset of sensory symptoms (pain, numbness and paresthesia) that then persisted for at least 3 months. Pain was present symmetrically in the hands and feet (a body map is shown). Possible neuropathic pain was fulfilled in 100% of cases. Bed-side clinical sensory examination and quantitative sensory examination revealed sensory loss in the hands and feet and all subjects met criteria for probable neuropathic pain. Skin biopsy revealed reduced intra-epidermal nerve fibers confirming a lesion at structural level and 95% of study participants met criteria for definite neuropathic pain. Data used in figure derived from Vale et al., [92].