University Department of Anesthesiology and Pain Therapy, University Hospital of Bern, Inselspital, 3010 Bern, Switzerland University Department of Obstetrics and Gynecology, University Hospital of Bern, Inselspital, Bern, Switzerland Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Denmark.
Pain. 2010 Dec;151(3):798-805. doi: 10.1016/j.pain.2010.09.017.
Widespread central hypersensitivity is present in chronic pain and contributes to pain and disability. According to animal studies, expansion of receptive fields of spinal cord neurons is involved in central hypersensitivity. We recently developed a method to quantify nociceptive receptive fields in humans using spinal withdrawal reflexes. Here we hypothesized that patients with chronic pelvic pain display enlarged reflex receptive fields. Secondary endpoints were subjective pain thresholds and nociceptive withdrawal reflex thresholds after single and repeated (temporal summation) electrical stimulation. 20 patients and 25 pain-free subjects were tested. Electrical stimuli were applied to 10 sites on the foot sole for evoking reflexes in the tibialis anterior muscle. The reflex receptive field was defined as the area of the foot (fraction of the foot sole) from which a muscle contraction was evoked. For the secondary endpoints, the stimuli were applied to the cutaneous innervation area of the sural nerve. Medians (25-75 percentiles) of fraction of the foot sole in patients and controls were 0.48 (0.38-0.54) and 0.33 (0.27-0.39), respectively (P=0.008). Pain and reflex thresholds after sural nerve stimulation were significantly lower in patients than in controls (P<0.001 for all measurements). This study provides for the first time evidence for widespread expansion of reflex receptive fields in chronic pain patients. It thereby identifies a mechanism involved in central hypersensitivity in human chronic pain. Reverting the expansion of nociceptive receptive fields and exploring the prognostic meaning of this phenomenon may become future targets of clinical research.
广泛的中枢敏化存在于慢性疼痛中,并导致疼痛和残疾。根据动物研究,脊髓神经元感受野的扩大与中枢敏化有关。我们最近开发了一种使用脊髓退缩反射来量化人类伤害性感受野的方法。在这里,我们假设慢性盆腔疼痛患者表现出扩大的反射感受野。次要终点是单次和重复(时间总和)电刺激后主观疼痛阈值和伤害性退缩反射阈值。我们测试了 20 名患者和 25 名无痛受试者。将电刺激施加到足底的 10 个部位,以在前胫骨肌肉中引发反射。反射感受野定义为引发肌肉收缩的足部区域(足部的一部分)。对于次要终点,刺激施加到腓肠神经的皮肤神经支配区域。患者和对照组足部分数的中位数(25-75 百分位数)分别为 0.48(0.38-0.54)和 0.33(0.27-0.39)(P=0.008)。与对照组相比,腓肠神经刺激后的疼痛和反射阈值在患者中明显更低(所有测量值均为 P<0.001)。本研究首次提供了慢性疼痛患者反射感受野广泛扩大的证据。它因此确定了人类慢性疼痛中中枢敏化涉及的机制。逆转伤害性感受野的扩大并探索这种现象的预后意义可能成为未来临床研究的目标。
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