Thermography-Musculskeletal Sympathetic Skin Response Studies
Medical Thermography For Weather-Sensitive Pain (Sympathetic Galvonic Skin Studies)
Medical Thermography for weather-sensitive pain is a sensitive, objective test that utilizes an electronic infrared imaging device to measure the body’s skin temperature (sympathetic galvonic skin response). The procedure is harmless, non-invasive, and does not use ionizing radiation.
While safeguards are built into the test to assure that the findings are both consistent and reproducible over time, there are several “Do’s and “Don’ts” for the procedure that can help minimize those things that can inappropriately impact the outcome.
- Don’t sunbathe or use a tanning bed for 48 hours prior to the exam.
- Do not have an EMG/ Nerve Conduction study, use a Tens unit, have physical therapy or an acupuncture treatment prior to the exam.
- Do shower and keep your skin clean of any ointments or lotion prior to the exam.
Because skin temperature is controlled by the “Sympathetic” portion of the nervous system, if there is a temperature difference greater than or equal to one degree centigrade from one side of the body to the other, then there is dysfunction of the sympathetic system. Most, but not all, sympathetic dysfunction syndromes are painful. If the pain becomes progressive and severe, it is referred to as RSD (reflex sympathetic dystrophy).
While there are many disorders that can lead to altered skin temperature, thermography is really the only way to measure large regions of skin temperature while simultaneously mapping the distribution of asymmetry. In order for the procedure to be clinically useful, a physician trained in the differential diagnosis of disorders that create thermographic abnormalities must interpret it.
For example, a patient with neck and arm pain presents with abnormally persistent, weather-sensitive pain. Other studies have not helped formulate a treatment program that provides relief. A thermographic study was done and showed changes in the entire limb, tracking on the inside, medial portion of the arm and forearm. To make use of the findings, the treating doctor must know that such an abnormality can occur with a strained ligament in the wrist, thoracic outlet syndrome, or a “C” fiber mediated nerve root irritation from a cervical facet or disk in the neck.
Once the presence of abnormality is discovered, treatment emphasis may very well shift from a pain management approach alone to one that also emphasizes improved circulation and reduction of those factors that inhibit normal nerve and vascular function.
Traditionally the prognosis for the resolution of symptoms with sympathetic pain syndromes is poor. Surgical interventions often worsen the disorder, and as a result treatments have emphasized use of pharmacologic agents, physical therapy, and repeated sympathetic nerve blocks.
Due to its sensitivity and unique ability to map and record the distribution and presence of skin temperature asymmetry (sympathetic skin response), thermography has facilitated breakthroughs in the way sympathetic pain is diagnosed and treated while improving the chances for a favorable treatment outcome.
Dr. Schwartz is President of the American Academy of Thermology.