脑卒中肩手综合征患者感觉障碍的定量分析

背景：脑卒中偏瘫后肩手综合征(shoulder-hand svndrome，SHS)患者感觉减退已被证实，而感觉障碍的评估多用问卷式调查或仅为粗略临床检查来完成，难以精确评估。目的：运用定量感觉检查技术(quantitative sensory testing，QST)检查脑卒中后肩手综合征观察组和脑卒中对照组各15例患者的温度觉及振动觉，并进行定量分析，以了解小纤维神经功能状态及其与肩手综合征的关系。设计：病例对照研究(case-control studv)。地点和对象：研究地点为中南大学湘雅三医院，对象涉及2000-06／2001-04湘雅三医院门诊及住院脑卒中后瘫痪病例。方法：用界限法分别检查观察组与对照组偏瘫侧上肢大鱼际掌侧温度觉阈值与拇指掌侧振动觉阈值。检查温度觉时，使用一个小的与检测区皮肤接触的热电极探头，探头温度以1℃／s速度递增(热觉、热痛觉)或递减(冷觉、冷痛觉)，直至受检者产生感觉的那一刻由受检者本人按下按钮停止刺激。得到一个温度觉阈值，探头温度恢复到预置温度准备下一次刺激。重复4次得到平均温度觉阈值。在检测振动觉时，振动器的刺激强度以0．1-12μm／s的速度递增，重复检测6次。主要观察指标：感觉障碍发生率，温度觉、痛觉及振动觉的数据。结果：SHS组中感觉障碍发生率为67％较对照组27％显著增高(P&;lt;0．05)。SHS组与对照组定量感觉比较，主要表现为冷觉阈值降低(分别为26．73&;#177;4．48，29．89&;#177;1．57，P&;lt;0．05)，热觉阈值增高(分别为36．83&;#177;1．90，35．40&;#177;0．89，P&;lt;0．05)。冷痛觉阈值、热痛觉阈值与振动觉阈值之间的差异无显著性意义。冷痛觉阈值与冷觉阈值的差值(P&;lt;0．01)及热痛觉阈值与热觉阈值之间差值(P&;lt;0．01)差异有显著性意义。结论：脑卒中偏瘫后SHS患者感觉障碍发生率显著增高。主要形式为温度觉减退和痛觉过敏。C类和AB类神经纤维功能障碍可能在SHS发病中起重要作用。     

肩手综合征定量感觉测定的临床研究

目的运用定量感觉检查技术对中风后肩手综合征(SHS)患者的温度觉及振动觉进行定量分析,以了解小纤维神经功能状态及其与肩手综合征的关系。方法应用神经感觉定量分析仪用界限法分别检查观察组SHS组(70例)与对照组(70例)偏瘫侧上肢大鱼际掌侧温度觉阈值与拇指掌侧振动觉阈值。结果SHS组中感觉障碍发生率较对照组显著增高(P<0.05)。SHS组与对照组定量感觉比较,主要表现为冷觉阈值降低(P<0.05),热觉阈值增高(P<0.05)。冷痛觉阈值、热痛觉阈值与振动觉阈值之间的差异无显著性。冷痛觉阈值与冷觉阈值的差值(P<0.01)及热痛觉阈值与热觉阈值之间差值(P<0.01)有显著性差异。结论中风偏瘫后SHS病人感觉障碍发生率显著增高。主要形式为温度觉减退和痛觉过敏。C类和Aδ类神经纤维功能障碍可能在SHS发病中起重要作用。     

正常成人躯干皮肤温度觉阈值测定

目的测定成人躯干皮肤温度觉正常值。方法应用温度感觉分析仪对123名健康成人躯干双侧T3、T7、T11关键点皮肤进行检测。结果测得冷觉、热觉、冷痛觉、热痛觉感觉阈值。冷觉和热觉阈值标准差较热痛觉小;冷痛觉阈值跨度最大;热痛觉阈值随节段下降有增大趋势;中年组较青年组阈值有增大趋势。结论躯干皮肤温度觉和温痛觉阈值正常参考值应按不同节段、年龄分别建模。冷觉、热觉个体差异较小,冷痛觉、热痛觉个体差异较大。     

带状疱疹与带状疱疹后神经痛患者温度觉阈值变化及其意义

目的:分析躯干部位带状疱疹、带状疱疹后神经痛患者皮肤温度觉阈值的变化与差异,推测其感觉功能改变及疼痛的病理机制.方法:应用NA-Ⅱ温度觉定量分析仪测定躯干部位带状疱疹、带状疱疹后神经痛患者及对照组相应皮肤的温度觉阈值.结果:带状疱疹后神经痛患者较带状疱疹患者皮肤的冷觉、热觉、热痛觉阈值均升高,其中冷觉阈值升高最为明显.带状疱疹患者冷觉与热觉阈值之间相关性无统计学意义,而带状疱疹后神经痛患者冷觉与热觉阈值之间呈负相关.结论:病变发展过程中,Aδ,C类神经纤维损伤程度有所加重,并以传导冷觉的Aδ神经纤维受损更为严重,表现为带状疱疹后神经痛患者对冷觉、热觉和热痛觉耐受性高于带状疱疹患者,而且对温度觉或痛觉的辨别度减低.     

正常人上肢不同部位的温度觉阈值20例观察

目的初步探讨正常人温度觉阈值的正常范围,以及各阈值与性别、部位之间的关系。方法用神经感觉分析仪(TSA-Ⅱ)的Limits法测定20例正常人上肢10个部位的冷觉、温觉、冷痛、热痛阈值并进行比较分析。结果各部位的冷觉、温觉个体差异不显著,冷痛觉和热痛觉的个体差异比较明显;男女之间在有些部位的温度觉阈值上有一定差异;左右侧在某些部位和某些温度觉方面有一定的差异。结论正常人的温度觉阈值与性别、部位有一定关系。     

牛痘疫苗接种家兔炎症皮肤提取物治疗脊髓损伤后神经病理性疼痛的定量感觉检查研究

目的:分析脊髓损伤(spinal cord injury,SCI)后神经病理性疼痛患者损伤平面的皮肤感觉阈值变化与差异,推测牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平)治疗SCI后神经病理性疼痛的作用机制。方法:39例SCI患者根据神经病理性疼痛的视觉模拟量表评分及使用神经妥乐平的不同情况分为轻、中、重3组,应用定量感觉检查(Quantitative sensory testing,QST)的方法,测试损伤平面皮肤的单丝触觉、冷觉阈值、热觉阈值以及冷痛觉阈值、热痛觉阈值,并与20例正常健康者进行比较。结果:与正常健康者相比,SCI患者损伤平面的单丝触觉阈、热觉阈均明显提高,冷觉阈明显降低。与无明显疼痛者比较,中、重度神经病理性疼痛者的单丝触觉阈、冷痛阈和热痛阈值间的差异存在统计学意义;神经妥乐平治疗有效者与无效者比较,冷痛阈、热痛阈间差异均存在统计学意义。结论:神经妥乐平治疗SCI后的神经病理性疼痛具有其特定的解剖生理学基础。通过QST筛查,有利于对SCI后的神经病理性疼痛进行早期干预。     

糖尿病周围神经病变多种简易感觉检查方法的评价

目的:评价多种简易感觉检查方法(EST)诊断糖尿病周围神经病变(DPN)的真实性、可靠性。方法:对185例住院2型糖尿病患者进行神经传导速度(NCV)及EST检查,包括10g尼龙丝压力觉、40g针头刺痛觉、温度觉、振动感觉阈值检查。以NCV检查作为"金标准",分别比较各检查方法诊断DPN的约登指数及κ值。结果:各检查方法与NCV检查均呈正相关(P=0.000)。压力觉检查约登指数、κ值分别为44.67%、0.465;针头刺痛觉检查分别为40.66%、0.399;温度觉检查分别为26.13%、0.278;振动感觉阈值检查分别为19.29%、0.208;压力觉联合痛觉检查分别为47.76%、0.461;压力觉联合温度觉检查分别为54.70%、0.555;压力觉联合振动觉检查分别为46.89%、0.482;痛觉联合温度觉检查分别为41.16%、0.402;温度觉联合振动觉检查分别为30.48%、0.323;痛觉联合振动觉检查分别为38.72%、0.379。结论:10g尼龙丝压力觉联合温度觉检查真实性、可靠性最好,推荐作为2型糖尿病患者筛查DPN的常规检查方法。     

神经根型颈椎病的定量感觉测定

目的:运用定量感觉检查技术对神经根型颈椎病患者的温度觉进行定量分析,以了解神经根型颈椎病患者小纤维神经的功能状态。方法:神经根型颈椎病组为2005-01/04于卫生部北京医院疼痛诊疗中心就诊,并被明确诊断为神经根型颈椎病的患者20例,其中男8例,女12例;年龄33～70(49.8±11.5)岁。所选病例均为单侧上肢出现症状(左侧10例,右侧10例),且检查前1周未进行理疗或神经阻滞治疗。对照组选择同期在疼痛诊疗中心就诊的非颈椎病患者及志愿者20例,其中男8例,女12例;年龄23～75(49.7±14.7)岁。应用神经感觉定量分析仪界限法检查双上肢大鱼际掌侧冷感觉、热感觉、冷痛觉、热痛觉阈值。结果:20例神经根型颈椎病患者和20例对照者,均进入结果分析。①神经根型颈椎病组患侧冷感觉阈值低于健侧,热感觉阈值高于健侧[(29.00±1.26)℃,(30.00±1.06)℃;(35.04±0.87)℃,(34.14±0.99)℃,P<0.05]。冷痛觉和热痛觉阈值患侧与健侧比较,差异无显著性(P>0.05)。②神经根型颈椎病组患侧与健侧阈值之差和对照组双侧阈值之差进行比较可见:冷感觉、热感觉、冷痛觉和热痛觉差异均有显著性[(-1.01±0.57)℃,(0.04±0.28)℃;(0.89±0.39)℃,(0.05±0.26)℃;(2.49±1.10)℃,(0.28±1.79)℃;(-1.62±0.86)℃,(0.17±1.10)℃,P<0.01]。颈椎病组患侧冷感觉和热痛觉阈值比健侧低,热感觉和冷痛觉阈值比健侧高。结论:神经根型颈椎病患者感觉障碍发生率显著增高。主要形式为温度觉减退和痛觉过敏,提示C类和Aδ类神经纤维出现功能障碍。     

神经根型颈椎病的定量感觉测定

目的：运用定量感觉检查技术对神经根型颈椎病患者的温度觉进行定量分析，以了解神经根型颈椎病患者小纤维神经的功能状态。 方法：神经根型颈椎病组为2005—01／04于卫生部北京医院疼痛诊疗中心就诊，并被明确诊断为神经根型颈椎病的患者20例，其中男8例，女12例；年龄33～70（49．8&;#177;11．5）岁。所选病例均为单侧上肢出现症状（左侧10例，右侧10例），且检查前1周未进行理疗或神经阻滞治疗。对照组选择同期在疼痛诊疗中心就诊的非颈椎病患者及志愿者20例，其中男8例，女12例；年龄23&;#177;75（49．7&;#177;14．7）岁。应用神经感觉定量分析仪界限法检查双上肢大鱼际掌侧冷感觉、热感觉．冷痛觉．热痛觉阈值。 结果：20例神经根型颈椎病患者和20例对照者，均进入结果分析。①神经根型颈椎病组患侧冷感觉阈值低于健侧，热感觉阈值高于健侧[（29．00&;#177;1．26）℃，（30．00&;#177;1．06）℃：（35．04&;#177;0．87）℃，（34．14&;#177;0．99）℃，P〈0．05]。冷痛觉和热痛觉阈值患侧与健侧比较，差异无显著性（P〉0．05）。②神经根型颈椎病组患侧与健侧阚值之差和对照组双侧阈值之差进行比较可见：冷感觉．热感觉、冷痛觉和热痛觉差异均有显著性[（-1．01&;#177;o．57）℃，（0．04&;#177;0．28）℃；（0．89&;#177;0．39）℃，（0．05&;#177;0．26）℃；（2．49&;#177;1．10）℃，（0．28&;#177;1．79）℃；（-1．62&;#177;0．86）℃，（0．17&;#177;1．10）℃，P〈0．01]。颈椎病组患侧冷感觉和热痛觉阈值比健侧低，热感觉和冷痛觉阈值比健侧高。 结论：神经根型颈椎病患者感觉障碍发生率显著增高。主要形式为温度觉减退和痛觉过敏，提示C类和A8类神经纤维出现功能障碍。     

脑卒中后肩-手综合征的神经电生理分析

目的通过对临床诊断的脑卒中后肩手综合征(shouder-hand syndrome,SHS)患者神经电生理指标的分析,明确并初步探讨周围神经损伤在SHS发生发展机制中的作用。方法将58例脑卒中患者分为SHS组(39例,伴SHS)和对照组(19例,不伴SHS),分别进行正中神经的针极肌电图(EMG)和神经传导测定。结果针极肌电图检查SHS组39例(100%)均检出插入电位异常,测得纤颤电位和正锐波,异常率明显高于对照组(P＜0．01)。SHS组感觉神经动作电位波幅为(7．77±4．34)mV,复合肌肉动作电位波幅为(10．13±3．15)mV,均较对照组明显降低(P＜0．05),且感觉神经波幅下降程度较运动神经明显(P＜0．05)。结论电生理检查证实SHS的病理生理改变中有周围神经损害因素参与,周围神经损害以轴索变性为主,且感觉神经受累程度重于运动神经。     

Quantitative sensory studies in complex regional pain syndrome type 1/RSD

OBJECTIVE: Patients with complex regional pain syndrome type I (CRPSD1) may have thermal allodynia after application of a non-noxious thermal stimulus to the affected limb. We measured the warm, cold, heat-evoked pain threshold and the cold-evoked pain threshold in the affected area of 16 control patients and patients with complex regional pain syndrome type 1/RSD to test the hypothesis that allodynia results from an abnormality in sensory physiology. SETTING: A contact thermode was used to apply a constant 1 degrees C/second increasing (warm and heat-evoked pain) or decreasing (cold and cold-evoked pain) thermal stimulus until the patient pressed the response button to show that a temperature change was felt by the patient. Student t test was used to compare thresholds in patients and control patients. RESULTS: The cold-evoked pain threshold in patients with CRPSD1/RSD (p <0.001) was significantly decreased when compared with the thresholds in control patients (i.e., a smaller decrease in temperature was necessary to elicit cold-pain in patients with CRPSD1/RSD than in control patients). The heat-evoked pain threshold in patients with CRPS1/RSD was (p <0.05) decreased significantly when compared with thresholds in control patients. The warm- and cold-detection thresholds in patients with CRPS1/RSD were similar to the thresholds in control patients. CONCLUSIONS: This study suggests that thermal allodynia in patients with CRPS1/RSD results from decreased cold-evoked and heat-evoked pain thresholds. The thermal pain thresholds are reset (decreased) so that non-noxious thermal stimuli are perceived to be pain (allodynia).     

Noxious heat evokes stronger sharp and annoying sensations in women than men in hairy skin but not in glabrous skin

Brief noxious heat evokes more intense pain in women than in men; however, sex differences in the intensity of pain sensations evoked in hairy and glabrous skins are not clearly understood. Glabrous skin putatively lacks the type of A-delta nociceptors that underlie heat-evoked sharp sensation. Therefore, we assessed whether noxious heat-evoked pain qualities differed for hairy and glabrous skins and whether sex differences exist in these evoked pains. We applied a prolonged (30 s) ramped noxious heat stimulus to the dorsal and ventral aspects of the feet of 16 males and 16 females. Stimuli were calibrated in each subject to evoke a peak pain magnitude of 50/100. Subjects provided continuous online ratings of pain, annoyance, burning, sharp, stinging and cutting sensations in separate runs. The results indicate that both sex and skin type impact noxious heat-evoked sensations. Specifically, ratings of sharp sensations and annoyance evoked in hairy skin were significantly more intense in women than in men. Sharp, stinging and cutting sensations were evoked in glabrous skin, but the magnitude of these sensations was greater in hairy skin than glabrous skin; an effect only in females. Also, there was no sex difference in sharp sensation and annoyance in glabrous skin. These findings suggest that sharp sensations are evoked more prominently in hairy than in glabrous skin of women and that sharp sensations and annoyance play a prominent role in mediating aspects of pain-evoked from hairy skin in women.     

Clinical and physiologic evaluation of stellate ganglion blockade for complex regional pain syndrome type I. (Ludwig-Maximilians-University, Munich, Germany) Clin J Pain. 2001;17:94–100.

This study measured the warm, cold, heat-evoked pain threshold and the cold-evoked pain threshold in the affected area of 16 control patients and patients with complex regional pain syndrome type 1/RSD (CRPSD1) to test the hypothesis that allodynia results from an abnormality in sensory physiology. The cold-evoked pain threshold in patients with CRPSD1/RSD was significantly decreased when compared with the thresholds in control patients (ie, a smaller decrease in temperature was necessary to elicit cold-pain in patients with CRPSD1/RSD than in control patients). The heat-evoked pain threshold in patients with CRPSD1/RSD was decreased significantly when compared with thresholds in control patients. The warm-detection and cold-detection thresholds in patients with CRPS1/RSD were similar to the thresholds in control patients. Conclude that the study suggests that thermal allodynia in patients with CRPS1/RSD resulted from decreased cold-evoked and heat-evoked pain thresholds. The thermal pain thresholds are reset so that non-noxious thermal stimuli are perceived to be pain (allodynia).     

Small- and large-fiber involvement in early diabetic neuropathy: a study with the medial plantar response and sensory thresholds

Small- and large-fiber function in diabetic neuropathy was studied in 68 patients (mean age 45.4 +/- 12.9 yr; 27 type I and 41 type II diabetics) with psychophysical tests of vibration and thermal sensation and neurophysiological measurements, including the medial plantar sensory action potential (MPSAP). Thermal sensitivity at the dorsolateral aspect of the foot (Pfizer thermal tester) correlated significantly with vibration thresholds (Somedic vibrameter) at three sites in the foot and two in the hand. Forty patients had normal sensory thresholds, but 18 of these lacked an MPSAP. Smaller groups had a single abnormal sensory threshold: 12 (18%) had an abnormal vibration threshold, and 24 (35%) had abnormal thermal sensitivity; 8 of the former group and 17 of the latter group lacked an MPSAP response. Only 8 (12%) had both abnormal vibration and thermal sensation (6 without an MPSAP). Fifteen of the 17 symptomatic patients had lost the MPSAP, but there was no consistent pattern of sensory loss. In this relatively young group of diabetics, more patients showed absent MPSAP responses than an abnormality in either sensory test on its own. The MPSAP is frequently absent in patients with no abnormalities in psychophysical tests of peripheral large-fiber function (vibration sensation) and small-fiber function (thermal sensitivity).     

Psychophysical observations on patients with neuropathic pain relieved by a sympathetic block

Patients with sympathetically maintained pain (SMP) were tested with noxious heat pulses, innocuous mechanical stimuli, and transcutaneous electrical nerve stimulation before and during local anesthetic sympathetic blocks that relieved their pain. The perceived intensity of the pain evoked by these stimuli was measured by the patients' responses on a visual analog scale and compared to the responses obtained when the same stimuli were applied to contralateral normal skin. In 5 of 7 patients tested, graded noxious heat stimuli (43-51 degrees C) applied to painful skin resulted in heat-pain intensity ratings that were essentially identical to the responses obtained when the same stimuli were applied to the normal side. Of the remaining two patients, one was clearly hypoalgesic for heat-pain and the other was probably hyperalgesic. The normal and subnormal heat-evoked responses obtained from abnormal skin were unchanged during completely successful sympathetic blocks. Trains of noxious heat pulses (52 degrees C) evoked summation of the second pain sensation in each of the 4 patients tested. This summation effect was normal and unaffected by a sympathetic block. Four of the patients had allodynia evoked by mechanical stimulation. In each of the 3 allodynia cases tested, transcutaneous nerve stimulation at an intensity that was at threshold for detection evoked burning pain and a coexistent sensation of tingle, indicating that both sensations were due to the activation of A beta axons. Patients without touch-evoked pain reported that electrical stimuli at threshold for detection produced only the sensation of tingle. The pains evoked by touch and by threshold-strength nerve stimulation were eliminated during sympathetic block. In patients with allodynia, trains of gentle mechanical stimuli and trains of threshold-strength electrical nerve stimuli produced summation of the intensity of the burning pain sensation when the stimuli were presented at 0.3 Hz. These results add to a growing body of evidence indicating that the touch-evoked pain of some patients is due to abnormal central activity evoked by input from A beta low-threshold mechanoreceptors. The coexistence of A beta-evoked pain with normal heat-evoked pain and normal heat-pain summation suggests that the central abnormality cannot be a simple hypersensitivity of wide-dynamic-range neurons. The effect of sympathetic blockade on A beta-evoked pain and its summation suggests that the crucial sympathetic interaction may take place centrally. The results show that there is considerable heterogeneity of sensory abnormalities among patients with SMP.(ABSTRACT TRUNCATED AT 400 WORDS)     

2型糖尿病粗神经纤维损伤血清空腹C肽水平变化

目的研究2型糖尿病粗细神经纤维损伤血清空腹c肽水平变化。方法应用振动感觉分析仪及定量感觉障碍分析检测仪对1118例2型糖尿病患者行振动感觉,冷感觉,温感觉,冷痛觉,热痛觉检测,同时行空腹血清C肽水平检测。结果粗神经纤维损伤的2型糖尿病患者空腹血清C肽水平为（0．56±0．49）nmol／L,明显低于细神经纤维损伤的空腹血清C肽水平（0．64±0．58）nmol／L和无感觉神经纤维损伤的空腹血清C肽水平（0．72±0．49）nmol／L,P〈0．05。结论低空腹c肽水平与粗有髓神经纤维损伤明显相关。     

Masseter inhibitory periods and sensations evoked by electrical tooth pulp stimulation

The masseter inhibitory period and sensations evoked by electrical tooth pulp stimulation were assessed in 30 human subjects. Five intensities of electrical stimuli, producing sensations varying from below sensory detection threshold to suprathreshold pain, were applied to upper central incisors. At each stimulus intensity a train of 30, 1-msec, cathodal pulses with an interpulse interval of 2 sec was applied. The averaged masseter activity evoked by the 30 pulses at a fixed stimulus intensity was compared to the quality of the sensation elicited.The threshold for the masseter inhibitory period coincided approximately with an individual's detection threshold for the tooth pulp stimulation. Three configurations of masseter inhibitory periods (single, double and merged) were produced by different stimulus intensities. However, no particular configuration was associated unequivocally with pain sensation. Increases in stimulus intensity evoked changes both in the configuration of the masseter inhibitory period and in the quality of the sensation produced. Chi square analyses showed significant, but progressively weaker, associations between: (1) masseter inhibitory period configuration and stimulus intensity; (2) quality of sensation and stimulus intensity; and (3) quality of sensation and masseter inhibitory period configuration. The weakness of the association between the quality of sensation and masseter inhibitory period configuration also was demonstrated in a double-blind study of the effects of a narcotic analgesic, fentanyl. Although the strengths of non-pain and pain sensations were reduced significantly after fentanyl, there were no changes in the masseter inhibitory periods.     

Hypoaesthesia occurs with sensory hypersensitivity in chronic whiplash--further evidence of a neuropathic condition

Hypersensitivity to a variety of stimuli has been shown in whiplash associated disorders and may be indicative of peripheral nerve involvement. This cross-sectional study utilised Quantitative sensory testing (QST) including vibration, thermal, electrical detection thresholds as an indirect measure of primary afferents that mediate innocuous and painful sensation. Pain thresholds and psychological distress (SCL-90-R) were also measured. Thirty-one subjects with chronic whiplash (>3 months, NDI: 49+/-17) and 31 controls participated. The whiplash group demonstrated elevated vibration, heat and electrical detection thresholds at most hand sites compared to controls (p<0.05). Electrical detection thresholds in the lower limb were no different from controls (p=0.83). Mechanical and cold pain thresholds were lower in the whiplash group (p<0.05) with no group difference in heat pain thresholds (p>0.1). SCL-90 scores were higher in the whiplash group but did not impact on any of the sensory measures. A combination of pain threshold and detection measures best predicted the whiplash group. Sensory hypoaesthesia and hypersensitivity co-exist in the chronic whiplash condition. These findings may indicate peripheral afferent nerve fibre involvement but could be a further manifestation of disordered central pain processing.     

Factors Associated with the Initial Sensations of Smoking among Smokers with Mental Illness

People with mental illnesses (MI) have a disproportionate smoking prevalence and associated disease burden. Smoking initiation among people with MI is poorly understood. However, the sensations experienced during smoking initiation predict continued smoking and nicotine dependence. Yet, few studies have examined the initial experiences of smoking among people with MI. Thus, the aim of this study was to explore factors associated with the initial sensations of smoking in people with MI. Smokers in an inpatient psychiatric facility (n?=?123) were surveyed. Data obtained included information on demographics, smoking and secondhand smoke (SHS) exposure, psychiatric diagnoses, and sensations of initial smoking. Spearman correlations explored associations among initial smoking sensation variables; and binary logistic regression analyses examined the associations between study variables and groupings derived from initial sensations (i.e., “pleasant?+?buzz,” “unpleasant?+?buzz,” and “all” sensations). The most frequently reported initial smoking sensation was feeling dizzy (87%) and there were low to moderate correlations between unpleasant (e.g., cough, sick, nervous) and pleasant (e.g., good, relaxed) sensations. In logistic regression analyses, having higher perceived SHS exposure was significantly associated with the “pleasant?+?buzz” sensation grouping; and lower past week SHS exposure was associated with the “unpleasant?+?buzz” sensation grouping; but, no variables were associated with “all” sensation group. Initial smoking sensations are an uncharted avenue of exploration in understanding smoking initiation among people with MI. SHS exposure may be an important factor associated with the report of both unpleasant and pleasant initial sensations. Future studies are needed to further explore initial sensations in relation to the context of smoking initiation among people with MI.