Fernández-de-Las-Peñas César, Ge Hong-You, Arendt-Nielsen Lars, Cuadrado Maria Luz, Pareja Juan A
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Eur J Pain. 2007 May;11(4):475-82. doi: 10.1016/j.ejpain.2006.07.005. Epub 2006 Aug 21.
Referred pain and pain characteristics evoked from the upper trapezius muscle was investigated in 20 patients with chronic tension-type headache (CTTH) and 20 age- and gender-matched controls. A headache diary was kept for 4 weeks in order to confirm the diagnosis and record the pain history. Both upper trapezius muscles were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold (PPT) were recorded. The results show that referred pain was evoked in 85% and 50% on the dominant and non-dominant sides in CTTH patients, much higher than 55% and 25% in controls (P<0.01). Referred pain spread to the posterior-lateral aspect of the neck ipsi-lateral to the stimulated muscle in both patients and controls, with additional referral to the temple in most patients, but none in controls. Nearly half of the CTTH patients (45%) recognized the referred pain as their usual headache sensation, i.e. active TrPs. CTTH patients with active TrPs in the right upper trapezius muscle showed greater headache intensity and frequency, and longer headache duration than those with latent TrPs. CTTH patients with bilateral TrPs reported significantly decreased PPT than those with unilateral TrP (P<0.01). Our results showed that manual exploration of TrPs in the upper trapezius muscle elicited referred pain patterns in both CTTH patients and healthy subjects. In CTTH patients, the evoked referred pain and its sensory characteristics shared similar patterns as their habitual headache pain, consistent with active TrPs. Our results suggest that spatial summation of perceived pain and mechanical pain sensitivity exists in CTTH patients.
对20例慢性紧张型头痛（CTTH）患者和20例年龄及性别匹配的对照者的上斜方肌牵涉痛及诱发的疼痛特征进行了研究。为确诊并记录疼痛病史，让患者记录4周的头痛日记。以盲法检查双侧上斜方肌是否存在肌筋膜触发点（TrP）。记录局部和牵涉痛强度、牵涉痛模式及压痛阈值（PPT）。结果显示，CTTH患者优势侧和非优势侧的牵涉痛诱发率分别为85%和50%，远高于对照组的55%和25%（P<0.01）。患者和对照组中，牵涉痛均扩散至受刺激肌肉同侧颈部的后外侧，大多数患者还牵涉至颞部，但对照组无此情况。近一半的CTTH患者（45%）将牵涉痛识别为其常见的头痛感觉，即活跃触发点。右上斜方肌有活跃触发点的CTTH患者比有潜伏触发点的患者头痛强度更大、频率更高、持续时间更长。双侧有触发点的CTTH患者的PPT显著低于单侧有触发点的患者（P<0.01）。我们的结果表明，对上斜方肌触发点的手法探查在CTTH患者和健康受试者中均能诱发牵涉痛模式。在CTTH患者中，诱发的牵涉痛及其感觉特征与其习惯性头痛疼痛具有相似模式，与活跃触发点一致。我们的结果提示，CTTH患者存在疼痛感知的空间总和及机械性疼痛敏感性。
