Department of Physical Therapy, Universidad Granada.
Clin J Pain. 2010 Nov-Dec;26(9):798-806. doi: 10.1097/AJP.0b013e3181f18c36.
To describe the presence of widespread pressure pain hyperalgesia and myofascial trigger points (TrPs) in neck and shoulder muscles in patients with postmastectomy pain.
Twenty-nine women (mean age: 50±8 y) with postmastectomy pain and 23 matched healthy controls (mean age: 50±9 y) participated. Pressure pain thresholds (PPT) were bilaterally assessed over the C5-C6 zygapophyseal joint, the deltoid muscle, the second metacarpal, and the tibialis anterior muscle. TrPs in the upper trapezius, suboccipital, levator scapulae, sternocleidomastoid, scalene, infraspinatus, and pectoralis major muscles were explored. TrPs were considered active if the local and referred pain reproduced symptoms and the patient recognized the pain as familiar.
Twenty-five (86%) patients reported neck pain whereas 20 (69%) patients showed shoulder/axillary pain. The results showed that PPT levels were significantly decreased bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, second metacarpal, and tibialis anterior muscle in patients with postmastectomy pain as compared with controls (all sites, P<0.001). No significant differences in the magnitude of PPT decrease between sites were found (P=0.222). The mean number of active TrPs for each woman with postmastectomy pain was 5.4±1.8. Healthy controls only had latent TrPs (0.5±0.6). Patients with postmastectomy pain showed a greater number of TrPs than controls (P<0.001). In all muscles, there was significantly more active TrPs in patients with postmastectomy pain as compared with controls (P<0.001). Active TrPs in the pectoralis major (n=27, 93%), infraspinatus (n=23, 79%), and upper trapezius (n=19, 65%) muscles were the most prevalent in the affected side in the postmastectomy group. The number of active TrPs was positively correlated with neck (rs=0.392, P=0.036) and shoulder/axillary (rs=0.437, P=0.018) pain intensity.
Our findings revealed bilateral widespread pressure pain hypersensitivity in patients with postmastectomy pain. In addition, the local and referred pain elicited by active TrPs reproduced neck and shoulder/axillary complaints in these patients. These results suggest peripheral and central sensitization in patients with postmastectomy pain.
描述乳腺癌根治术后疼痛患者颈部和肩部肌肉中广泛存在的压痛点痛觉过敏和肌筋膜触发点（TrPs）。
29 名患有乳腺癌根治术后疼痛的女性（平均年龄：50±8 岁）和 23 名匹配的健康对照组（平均年龄：50±9 岁）参与了本研究。双侧评估 C5-C6 椎间关节、三角肌、第二掌骨和胫骨前肌的压痛阈值（PPT）。探测斜方肌上、下项线、肩胛提肌、胸锁乳突肌、斜角肌、冈下肌和胸大肌的 TrPs。如果局部和牵涉痛再现症状且患者识别出熟悉的疼痛，则认为 TrPs 为活动性。
25 名（86%）患者报告颈部疼痛，20 名（69%）患者出现肩部/腋窝疼痛。结果显示，与对照组相比，乳腺癌根治术后疼痛患者双侧 C5-C6 椎间关节、三角肌、第二掌骨和胫骨前肌的 PPT 水平显著降低（所有部位，P<0.001）。各部位 PPT 降低程度无显著差异（P=0.222）。每位乳腺癌根治术后疼痛患者的平均活动性 TrPs 数为 5.4±1.8。健康对照组仅存在潜伏性 TrPs（0.5±0.6）。与对照组相比，乳腺癌根治术后疼痛患者的 TrPs 数量更多（P<0.001）。在所有肌肉中，乳腺癌根治术后疼痛患者的活动性 TrPs 明显多于对照组（P<0.001）。与对照组相比，乳腺癌根治术后疼痛患者的胸大肌（n=27，93%）、冈下肌（n=23，79%）和斜方肌上束（n=19，65%）的活动性 TrPs 更为常见。在乳腺癌根治术后组中，患侧胸大肌、冈下肌和斜方肌上束的活动性 TrPs 数量与颈部（rs=0.392，P=0.036）和肩部/腋窝（rs=0.437，P=0.018）疼痛强度呈正相关。
我们的研究结果表明，乳腺癌根治术后疼痛患者存在双侧广泛的压痛性疼痛过敏。此外，由活动性 TrPs 引起的局部和牵涉痛再现了这些患者的颈部和肩部/腋窝疼痛。这些结果表明，乳腺癌根治术后疼痛患者存在外周和中枢敏化。
