Freynhagen Rainer, Rolke Roman, Baron Ralf, Tölle Thomas R, Rutjes Ann-Kathrein, Schu Stefan, Treede Rolf-Detlef
Department of Anesthesiology, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany.
Pain. 2008 Mar;135(1-2):65-74. doi: 10.1016/j.pain.2007.05.004. Epub 2007 Jun 13.
To assess whether pseudoradicular low-back pain may be associated with subclinical sensory deficits in the distal extremity, we applied the quantitative sensory testing protocol of the German Research Network on Neuropathic Pain (DFNS) in 15 patients with pseudoradicular pain distribution. Sixteen age- and gender-matched healthy control subjects as well as 12 patients with radicular pain syndromes (L4-S1) were studied with the same protocol. Radicular pain was diagnosed using clinical criteria (pain radiation beyond the knee, motor-, sensory-, or reflex deficits, positive Laségue's test). Z-score QST profiles revealed a selective loss of vibration detection, detection of v. Frey hair contact, and cold detection in the affected dermatomes in the radicular pain group. The contralateral dermatome was also affected, but to a lesser degree. In patients with pseudoradicular pain, the sensory profile was similar, but sensory loss was less pronounced than in the radicular pain patients. There was no significant difference between the two patient groups. Vibration detection was the most sensitive parameter with 73% abnormal values in radicular and 47% in pseudoradicular cases. These data verified the sensitivity of QST to detect sensory loss in radicular compression syndromes, and support a neuropathic component in low-back pain with radiculopathy. In contrast to some central pain syndromes this sensory loss involved predominantly large fiber functions. The subclinical sensory loss in pseudoradicular cases suggests that these patients may also have a neuropathic component of their chronic pain. The spatial incongruence of pain and sensory loss in pseudoradicular pain, however, may also indicate that the two are not causally related.
为了评估假性根性下背痛是否可能与远端肢体的亚临床感觉缺陷相关，我们对15例具有假性根性疼痛分布的患者应用了德国神经性疼痛研究网络（DFNS）的定量感觉测试方案。采用相同方案对16名年龄和性别匹配的健康对照者以及12例根性疼痛综合征（L4-S1）患者进行了研究。根性疼痛根据临床标准进行诊断（疼痛放射至膝关节以下、运动、感觉或反射缺陷、直腿抬高试验阳性）。Z评分定量感觉测试结果显示，根性疼痛组患侧皮节的振动觉、对冯·弗里氏毛接触的感觉及冷觉检测选择性丧失。对侧皮节也受到影响，但程度较轻。在假性根性疼痛患者中，感觉特征相似，但感觉丧失程度不如根性疼痛患者明显。两组患者之间无显著差异。振动觉检测是最敏感的参数，根性疼痛病例中73%的值异常，假性根性疼痛病例中47%的值异常。这些数据证实了定量感觉测试在检测根性压迫综合征感觉丧失方面的敏感性，并支持神经根病性下背痛存在神经病变成分。与一些中枢性疼痛综合征不同，这种感觉丧失主要涉及大纤维功能。假性根性疼痛病例中的亚临床感觉丧失表明，这些患者的慢性疼痛可能也存在神经病变成分。然而，假性根性疼痛中疼痛与感觉丧失的空间不一致也可能表明二者并无因果关系。
