Agostinho Claudia Maria Santos, Scherens Andrea, Richter Helmut, Schaub Claudia, Rolke Roman, Treede Rolf-Detlef, Maier Christoph
Department of Pain Management, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr-University Bochum, Germany.
Eur J Pain. 2009 Sep;13(8):779-85. doi: 10.1016/j.ejpain.2008.10.002. Epub 2008 Nov 18.
We investigated habituation effects during thermal quantitative sensory testing (tQST) using 8 repetitive measurements for thermal detection and pain thresholds. The same measurements were repeated two days later. 39 healthy subjects and 36 patients with chronic non-neuropathic pain syndromes (migraine, tension-type headache, non-radicular back pain) were enrolled. The pain intensity was assessed using an 11-point (0-10) numerical rating scale. Measurements correlated significantly over the two days in both groups (r=0.41...0.62). Warm detection (WDT) and heat pain threshold (HPT) revealed no significant differences over these days. Cold detection (CDT) and pain thresholds (CPT) showed significant differences but these were small compared to the range of normal variability (CDTDelta -0.28 degrees C; CPTDelta 1.51 degrees C). On both days, WDT showed no habituation during measurements. Although there was a small difference in CDT and CPT between first and second measurement, there was no habituation beyond the second stimuli. In contrast, HPT significantly increased between first and sixth stimuli, indicating pronounced habituation. Average HPT of first to third measurement was significantly lower than HPT of the fourth to sixth assessment (45.9 degrees C; 47.7 degrees C) with a good day-to-day repeatability. Repeatability and habituation was identical in both groups. Ongoing pain intensity in the patient groups correlated significantly with CDT/WDT but not with CPT, HPT, indicating that ongoing pain might suppress the sensitivity to non-painful stimuli. In summary, tQST proved a reliable diagnostic tool for clinical practice. Day-to-day differences were small but without clinical relevance. Habituation was most pronounced for HPT, probably due to peripheral fatigue of the receptors.
我们在热定量感觉测试（tQST）期间使用8次重复测量来检测热觉和痛觉阈值，研究了习惯化效应。两天后重复相同的测量。招募了39名健康受试者和36名患有慢性非神经性疼痛综合征（偏头痛、紧张型头痛、非根性背痛）的患者。使用11点（0 - 10）数字评分量表评估疼痛强度。两组在两天内的测量结果均显著相关（r = 0.41...0.62）。在这些日子里，温觉检测（WDT）和热痛阈值（HPT）没有显著差异。冷觉检测（CDT）和痛觉阈值（CPT）显示出显著差异，但与正常变异性范围相比很小（CDT变化 -0.28℃；CPT变化1.51℃）。在这两天中，WDT在测量期间未显示出习惯化。虽然第一次和第二次测量之间CDT和CPT存在微小差异，但在第二次刺激之后没有习惯化。相比之下，HPT在第一次和第六次刺激之间显著增加，表明有明显的习惯化。第一次到第三次测量的平均HPT显著低于第四次到第六次评估的HPT（45.9℃；47.7℃），且具有良好的每日重复性。两组的重复性和习惯化情况相同。患者组中持续的疼痛强度与CDT/WDT显著相关，但与CPT、HPT无关，这表明持续的疼痛可能会抑制对非疼痛刺激的敏感性。总之，tQST被证明是临床实践中一种可靠的诊断工具。每日差异很小，但无临床相关性。HPT的习惯化最为明显，可能是由于感受器的外周疲劳。
