Non-freezing cold injury develops after sustained exposure to cold temperatures, resulting in tissue cooling but not freezing. This can result in persistent sensory disturbance of the hands and feet including numbness, paraesthesia and chronic pain. Both vascular and neurological aetiologies of this pain have been suggested but remain unproven. We prospectively approached patients referred for clinical assessment of chronic pain following non-freezing cold injury between 12 February 2014 and 30 November 2016. Of 47 patients approached, 42 consented to undergo detailed neurological evaluations including: questionnaires to detail pain location and characteristics, structured neurological examination, quantitative sensory testing, nerve conduction studies and skin biopsy for intraepidermal nerve fibre assessment. Of the 42 study participants, all had experienced non-freezing cold injury while serving in the UK armed services and the majority were of African descent (76.2%) and male (95.2%). Many participants reported multiple exposures to cold. The median time between initial injury and referral was 3.72 years. Pain was principally localized to the hands and the feet, neuropathic in nature and in all study participants associated with cold hypersensitivity. Clinical examination and quantitative sensory testing were consistent with a sensory neuropathy. In all cases, large fibre nerve conduction studies were normal. The intraepidermal nerve fibre density was markedly reduced with 90.5% of participants having a count at or below the 0.05 centile of published normative controls. Using the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain grading for neuropathic pain, 100% had probable and 95.2% definite neuropathic pain. Chronic non-freezing cold injury is a disabling neuropathic pain disorder due to a sensory neuropathy. Why some individuals develop an acute painful sensory neuropathy on sustained cold exposure is not yet known, but individuals of African descent appear vulnerable. Screening tools, such as the DN4 questionnaire, and treatment algorithms for neuropathic pain should now be used in the management of these patients.

中文翻译：

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慢性非冷冻性冷伤害由于感觉神经病导致神经性疼痛

持续暴露于低温下会形成非冷冻的冷伤害，从而导致组织冷却但不会冻结。这可能会导致手和脚的持续感觉障碍，包括麻木，感觉异常和慢性疼痛。已经提出了这种疼痛的血管和神经病因，但尚未得到证实。我们前瞻性地接触了在2014年2月12日至2016年11月30日期间进行非冷冻性冷伤后进行慢性疼痛临床评估的患者。在47位患者中，有42位同意接受详细的神经系统评估，包括：详细疼痛位置和特征，结构神经系统问卷检查，定量感觉测试，神经传导研究和皮肤活检以评估表皮内神经纤维。在42位研究参与者中，在英国武装部队服役期间，所有人都遭受了非冰冻的冷伤害，其中大多数是非洲人后裔（76.2％）和男性（95.2％）。许多参与者报告多次暴露于寒冷中。初始伤害与转诊之间的中位时间为3.72年。疼痛主要位于手和脚，本质上是神经性的，并且在所有与感冒超敏反应有关的研究参与者中都存在。临床检查和定量感觉测试与感觉神经病一致。在所有情况下，大纤维神经传导研究均正常。表皮内神经纤维密度显着降低，有90.5％的参与者的计数等于或低于已发布的规范性对照的0.05百分位数。使用国际疼痛性疼痛研究分级协会的神经病理性疼痛特别兴趣小组，可以发现100％的患者可能患有神经性疼痛，而95.2％的患者患有明确的神经性疼痛。慢性非冷冻性冷伤害是由于感觉神经病引起的致残性神经病性疼痛疾病。为什么尚不知道某些人在持续的冷暴露下会出现急性疼痛感觉神经病的原因，但非洲人后裔似乎很脆弱。现在应该在这些患者的治疗中使用筛查工具，例如DN4问卷和神经性疼痛的治疗算法。为什么尚不知道某些人在持续的冷暴露下会出现急性疼痛感觉神经病的原因，但非洲人后裔似乎很脆弱。现在应该在这些患者的治疗中使用筛查工具，例如DN4问卷和神经性疼痛的治疗算法。为什么尚不知道某些人在持续的冷暴露下会出现急性疼痛感觉神经病的原因，但非洲人后裔似乎很脆弱。现在应该在这些患者的治疗中使用筛查工具，例如DN4问卷和神经性疼痛的治疗算法。