Drewes Asbjørn Mohr, Pedersen Jan, Reddy Hariprasad, Rasmussen Klaus, Funch-Jensen Peter, Arendt-Nielsen Lars, Gregersen Hans
Centre for Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg Hospital, Aalborg, Denmark.
Scand J Gastroenterol. 2006 Jun;41(6):640-9. doi: 10.1080/00365520500442559.
Patients with non-cardiac chest pain (NNCP) suffer from unexplained and often intractable pain which can pose a major clinical problem. The aim of this study was to investigate nociceptive processing in NNCP patients and their response to experimentally acid-induced oesophageal hyperalgesia using a multimodal stimulation protocol.
Ten highly selected patients with NCCP (mean age 43 years, 1 M) were compared with an age- and gender-matched group of 20 healthy subjects. After preconditioning, the distal oesophagus was painfully distended with a balloon using "impedance planimetry". This method assesses the luminal cross-sectional area of the oesophagus based on the electrical impedance of the fluid inside the balloon. The baseline distensions were done before and after pharmacological relaxation of the smooth muscle with 20 mg butylscopolamine. After baseline distensions, a series of up to 10 mechanical stimuli was performed (temporal summation). The stimulations were repeated after sensitization of the oesophagus induced by acid perfusion. The sensory intensities were assessed during the stimulations and the referred pain area was mapped.
At baseline distensions, no differences were seen between patients and controls before and after relaxation of the smooth muscles. The patients tolerated fewer repeated distensions than controls (4.8+/-0.5 versus 9.1+/-0.9; p=0.04) and had an increased size of the referred pain areas to the mechanical stimulations (32.9+/-6.2 versus 64.9+/-18.3 cm2; p=0.01). After sensitization with acid, the patients developed hyperalgesia (p<0.001), whereas no significant changes were seen in controls.
NCCP patients showed facilitated central pain mechanisms (temporal summation and visceral hyperalgesia after sensitization). This could be used in the diagnosis and understanding of the symptoms in these patients.
非心源性胸痛（NNCP）患者遭受不明原因且常难以治疗的疼痛，这可能构成一个重大的临床问题。本研究的目的是使用多模式刺激方案，调查NNCP患者的伤害性感受处理及其对实验性酸诱导的食管痛觉过敏的反应。
将10例精心挑选的NCCP患者（平均年龄43岁，1名男性）与20名年龄和性别匹配的健康受试者进行比较。预处理后，使用“阻抗平面测量法”用球囊使食管远端产生疼痛性扩张。该方法根据球囊内液体的电阻抗评估食管的管腔横截面积。在使用20mg丁溴东莨菪碱使平滑肌药理松弛之前和之后进行基线扩张。基线扩张后，进行一系列多达10次的机械刺激（时间总和）。在酸灌注诱导食管致敏后重复刺激。在刺激期间评估感觉强度并绘制牵涉痛区域。
在基线扩张时，平滑肌松弛前后患者和对照组之间未见差异。患者耐受的重复扩张次数少于对照组（4.8±0.5对9.仁±0.9；p=0.04），并且对机械刺激的牵涉痛区域面积增加（32.9±6.2对64.9±18.3cm2；p=0.01）。用酸致敏后，患者出现痛觉过敏（p<0.001），而对照组未见明显变化。
NCCP患者表现出中枢疼痛机制易化（致敏后时间总和和内脏痛觉过敏）。这可用于这些患者症状的诊断和理解。
