George Steven Z, Wittmer Virgil T, Fillingim Roger B, Robinson Michael E
Department of Physical Therapy, Brooks Center for Rehabilitation Studies, University of Florida, Gainesville, Florida 32611-0154, USA.
J Occup Rehabil. 2006 Mar;16(1):95-108. doi: 10.1007/s10926-005-9007-y.
Quantitative sensory testing has demonstrated a promising link between experimentally determined pain sensitivity and clinical pain. However, previous studies of quantitative sensory testing have not routinely considered the important influence of psychological factors on clinical pain. This study investigated whether measures of thermal pain sensitivity (temporal summation, first pulse response, and tolerance) contributed to clinical pain reports for patients with chronic low back pain, after controlling for depression or fear-avoidance beliefs about work.
Consecutive patients (n=27) with chronic low back pain were recruited from an interdisciplinary pain rehabilitation program in Jacksonville, FL. Patients completed validated self-report questionnaires for depression, fear-avoidance beliefs, clinical pain intensity, and clinical pain related disability. Patients also underwent quantitative sensory testing from previously described protocols to determine thermal pain sensitivity (temporal summation, first pulse response, and tolerance). Hierarchical regression models investigated the contribution of depression and thermal pain sensitivity to clinical pain intensity, and fear-avoidance beliefs and thermal pain sensitivity to clinical pain related disability.
None of the measures of thermal pain sensitivity contributed to clinical pain intensity after controlling for depression. Temporal summation of evoked thermal pain significantly contributed to clinical pain disability after controlling for fear-avoidance beliefs about work.
Measures of thermal pain sensitivity did not contribute to pain intensity, after controlling for depression. Fear-avoidance beliefs about work and temporal summation of evoked thermal pain significantly influenced pain related disability. These factors should be considered as potential outcome predictors for patients with work-related low back pain.
This study supported the neuromatrix theory of pain for patients with CLBP, as cognitive-evaluative factor contributed to pain perception, and cognitive-evaluative and sensory-discriminative factors uniquely contributed to an action program in response to chronic pain. Future research will determine if a predictive model consisting of fear-avoidance beliefs and temporal summation of evoked thermal pain has predictive validity for determining clinical outcome in rehabilitation or vocational settings.
定量感觉测试已证明实验确定的疼痛敏感性与临床疼痛之间存在有前景的联系。然而，先前关于定量感觉测试的研究并未常规考虑心理因素对临床疼痛的重要影响。本研究调查了在控制了对工作的抑郁或恐惧回避信念后，热痛敏感性测量指标（时间总和、首次脉冲反应和耐受性）是否有助于慢性下腰痛患者的临床疼痛报告。
从佛罗里达州杰克逊维尔的一个跨学科疼痛康复项目中招募了连续的慢性下腰痛患者（n = 27）。患者完成了关于抑郁、恐惧回避信念、临床疼痛强度和临床疼痛相关残疾的有效自我报告问卷。患者还按照先前描述的方案进行了定量感觉测试，以确定热痛敏感性（时间总和、首次脉冲反应和耐受性）。分层回归模型研究了抑郁和热痛敏感性对临床疼痛强度的贡献，以及恐惧回避信念和热痛敏感性对临床疼痛相关残疾的贡献。
在控制抑郁后，热痛敏感性测量指标均未对临床疼痛强度产生影响。在控制了对工作的恐惧回避信念后，诱发热痛的时间总和对临床疼痛残疾有显著贡献。
在控制抑郁后，热痛敏感性测量指标对疼痛强度没有影响。对工作的恐惧回避信念和诱发热痛的时间总和显著影响疼痛相关残疾。这些因素应被视为与工作相关的下腰痛患者潜在的结果预测指标。
本研究支持了慢性下腰痛患者的疼痛神经矩阵理论，因为认知评估因素有助于疼痛感知，而认知评估和感觉辨别因素独特地促成了应对慢性疼痛的行动方案。未来的研究将确定由恐惧回避信念和诱发热痛的时间总和组成的预测模型在确定康复或职业环境中的临床结果方面是否具有预测效度。
