Nederhand Marc J, Hermens Hermie J, Ijzerman Maarten J, Groothuis Karin G M, Turk Dennis C
Roessingh, Research & Development, Enschede, The Netherlands.
Clin J Pain. 2006 Jul-Aug;22(6):519-25. doi: 10.1097/01.ajp.0000202979.44163.da.
Studies using surface electromyography have demonstrated a reorganization of muscle activation patterns of the neck and shoulder muscles in patients with posttraumatic neck pain disability. The neurophysiologically oriented "pain adaptation" model explains this reorganization as a useful adaptation to prevent further pain and injury. The cognitive-behavioral-oriented "fear avoidance" model suggests that fear of movement, in addition to the effects of pain, modulates the muscle activation level. We analyzed the extent to which pain and fear of movement influenced the activation patterns of the upper trapezius muscle during the transition from acute to chronic posttraumatic neck pain. Ninety-two people with an acute traumatic neck injury after a motor vehicle accident were followed up for 24 weeks. Visual analog scale ratings of pain intensity, response on the Tampa Scale of Kinesophobia--fear of movement, and surface electromyography of the upper trapezius muscles during a submaximal isometric physical task were obtained at 1, 4, 8, 12, and 24 weeks after the motor vehicle accident. Multilevel analysis revealed that an increased level of both fear of movement (t value=-2.19, P=0.030) and pain intensity (t value=-2.94, P=0.004) were independently associated with a decreased level of muscle activation. Moreover, the results suggest that the association between fear of movement and lower muscle activity level is stronger in patients reporting high pain intensity (t value=2.15, P=0.033). The contribution of pain intensity to the muscle activation level appeared to decrease over time after the trauma (t value=2.58, P=0.011). The results support both the "pain adaptation" and the "fear avoidance" models. It is likely that the decrease in muscle activation level is aimed at "avoiding" the use of painful muscles.
使用表面肌电图的研究表明，创伤后颈部疼痛残疾患者的颈部和肩部肌肉激活模式发生了重组。以神经生理学为导向的“疼痛适应”模型将这种重组解释为一种有用的适应，以防止进一步的疼痛和损伤。以认知行为为导向的“恐惧回避”模型表明，除了疼痛的影响外，对运动的恐惧会调节肌肉激活水平。我们分析了疼痛和对运动的恐惧在创伤后颈部疼痛从急性转变为慢性的过程中对上斜方肌激活模式的影响程度。对92名机动车事故后急性创伤性颈部损伤患者进行了24周的随访。在机动车事故后的第1、4、8、12和24周，获得了疼痛强度的视觉模拟量表评分、坦帕运动恐惧量表（对运动的恐惧）的反应以及在次最大等长体力任务期间上斜方肌的表面肌电图。多水平分析显示，对运动的恐惧水平增加（t值=-2.19，P=0.030）和疼痛强度增加（t值=-2.94，P=0.004）均与肌肉激活水平降低独立相关。此外，结果表明，在报告高疼痛强度的患者中，对运动的恐惧与较低肌肉活动水平之间的关联更强（t值=2.15，P=0.033）。创伤后，疼痛强度对肌肉激活水平的贡献似乎随时间减少（t值=2.58，P=0.011）。结果支持“疼痛适应”和“恐惧回避”模型。肌肉激活水平的降低可能旨在“避免”使用疼痛的肌肉。
