Mailis A, Papagapiou M, Umana M, Cohodarevic T, Nowak J, Nicholson K
Comprehensive Pain Program, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Rheumatol. 2001 Jun;28(6):1385-93.
To address the prevalence and characteristics of nondermatomal somatosensory deficits (NDSD) in subjects with chronic pain in the context of compensation/litigation.
Data were collected via standardized history, examination, and patient- as well as physician-drawn body maps in a consecutive series of 194 subjects seen for the purpose of an independent medical examination.
Forty-nine subjects (25.3%) with primarily widespread pain (often diagnosed as fibromyalgia) presented with hemisensory or quadrotomal deficits to pinprick and other cutaneous stimuli on the side of lateralized pain or worse pain. The NDSD limbs often had impairment of vibration sense (not infrequently associated with "forehead vibration split"), reduced strength, dexterity or movement, and extreme sensitivity to superficial skin palpation or profound insensitivity to deep pain. Spatial, temporal, qualitative, and evolutionary patterns of NDSD emerged associated with cognitive/affective symptoms. NDSD subjects were more often born outside Canada, more likely to be injured at work, present with abnormal pain behavior, and have negative investigations.
NDSD are a prevalent problem associated with chronic pain. Future research should explore the prevalence of NDSD in other pain populations, the role of personality and related factors, and the underlying biological substrate of these deficits.
探讨在赔偿/诉讼背景下慢性疼痛患者中非皮节性躯体感觉障碍（NDSD）的患病率及特征。
通过标准化病史、检查以及患者和医生绘制的身体图谱，对连续194例因独立医学检查前来就诊的患者收集数据。
49例（25.3%）主要表现为广泛疼痛（常被诊断为纤维肌痛）的患者，在疼痛偏侧化或疼痛更严重一侧出现对针刺及其他皮肤刺激的半身感觉或四肢感觉障碍。NDSD肢体常伴有振动觉损害（常伴有“前额振动分离”）、力量减弱、灵活性或运动能力下降，以及对皮肤浅触极度敏感或对深部疼痛极度不敏感。NDSD的空间、时间、性质和演变模式与认知/情感症状相关。NDSD患者更多出生在加拿大境外，更有可能在工作中受伤，表现出异常疼痛行为，且检查结果为阴性。
NDSD是与慢性疼痛相关的常见问题。未来研究应探索NDSD在其他疼痛人群中的患病率、人格及相关因素的作用，以及这些障碍的潜在生物学基础。
