It is common for patients to experience heightened sensitivity of the area following a hand injury or surgery. It is thought to be the result of reduced sensory threshold to stimulus, or maladaptive central processing of incoming sensory information from the periphery. If the nerve tissues themselves are damaged, micro neuromas are another possibility (Rosen, 2012). This hypersensitivity or hyperaesthesia may include allodynia (when pain results from stimuli which would not normally provoke pain) or hyperalgesia (an increase in sensitivity to tactile stimuli).
Desensitisation programmes can be helpful in reducing this hypersensitivity by encouraging the sensory system to adapt and to re-learn a normal response to sensory input, decreasing the discomfort associated with touch in the hypersensitive area. A study in 2011 demonstrated statistically significant improvements in pain levels/discomfort at rest and with use or touch, a decreased size of the sensitive area and an improved ability to perform ADL’s and occupational activities (such as using a computer and tools) following a 6 week desensitisation programme (Goransson & Cederlund, 2011).
Treatment consists of graded exposure to textures and pressures. We begin with those that are just tolerable to the patient and progress the exposure as their sensitivity changes – constantly challenging the sensory system to adapt. For example:
Our Hand Therapists will be able to advise patients on what exercises are appropriate and monitor progress, ensuring central sensitisation does not occur.
References available on request.