Wollgarten-Hadamek Iris, Hohmeister Johanna, Demirakça Sueha, Zohsel Katrin, Flor Herta, Hermann Christiane
Department of Clinical and Cognitive Neuroscience, Central Institute of Mental Health, Mannheim, Germany.
Pain. 2009 Jan;141(1-2):165-72. doi: 10.1016/j.pain.2008.11.008. Epub 2008 Dec 17.
Studies in animals and humans suggest that neonatal and early infant pain or stress experiences can induce long-term alterations in somatosensory and pain processing. We studied pain and sensory sensitivity in school-aged children (9-16 years) who had suffered moderate (N=24) or severe (N=24) burn injuries in infancy (6-24 months of age) and 24 controls. Quantitative sensory testing entailing detection and pain thresholds for thermal and mechanical stimuli and perceptual sensitization to tonic heat and repetitive mechanical stimuli was performed. Two testing sites (thenar, trigeminal region), both not affected by the burn injury, were used to determine whether there are global changes in pain sensitivity. The result pattern suggests a differential impact of burn severity. Compared to controls, moderately burned children showed significantly higher mechanical detection thresholds (thenar) and significantly lower mechanical pain thresholds and significantly greater perceptual sensitization to repetitive mechanical stimuli (both testing sites). No significant alterations were observed for thermal stimuli. In contrast, severely burned children showed, compared to controls, primarily alterations in thermal pain sensitivity (elevated pain thresholds at both testing sites, significantly greater perceptual sensitization at the thenar). In these children, mechanical pain sensitivity and detection thresholds were not consistently altered. This differential pattern of altered sensory and pain sensitivity may reflect differences in experienced stress, pain and analgesic treatment between moderately and severely burned children. Most importantly, our findings suggest that early traumatic and painful injuries, such as burns, can induce global, long-term alterations in sensory and pain processing.
对动物和人类的研究表明，新生儿和婴儿早期的疼痛或应激经历可导致躯体感觉和疼痛处理的长期改变。我们研究了在婴儿期（6至24个月大）遭受中度（N = 24）或重度（N = 24）烧伤的学龄儿童（9至16岁）以及24名对照儿童的疼痛和感觉敏感性。进行了定量感觉测试，包括对热刺激和机械刺激的检测及疼痛阈值，以及对温热刺激和重复性机械刺激的感觉致敏性测试。使用两个未受烧伤影响的测试部位（大鱼际、三叉神经区域）来确定疼痛敏感性是否存在整体变化。结果模式表明烧伤严重程度的影响存在差异。与对照组相比，中度烧伤儿童的机械检测阈值（大鱼际）显著更高，机械疼痛阈值显著更低，对重复性机械刺激的感觉致敏性显著更强（两个测试部位均如此）。热刺激方面未观察到显著改变。相比之下，与对照组相比，重度烧伤儿童主要表现为热痛敏感性改变（两个测试部位的疼痛阈值升高，大鱼际的感觉致敏性显著更强）。在这些儿童中，机械疼痛敏感性和检测阈值并未持续改变。这种感觉和疼痛敏感性改变的差异模式可能反映了中度和重度烧伤儿童在经历的应激、疼痛和镇痛治疗方面的差异。最重要的是，我们的研究结果表明，早期创伤性和疼痛性损伤，如烧伤，可导致感觉和疼痛处理的整体长期改变。
