Javanshir Khodabakhsh, Ortega-Santiago Ricardo, Mohseni-Bandpei Mohammad Ali, Miangolarra-Page Juan C, Fernández-de-Las-Peñas César
Physiotherapy Department, University of Social Welfare and Rehabilitation Sciences, Kodakyar St, Evin, Tehran, Iran.
J Manipulative Physiol Ther. 2010 Sep;33(7):493-9. doi: 10.1016/j.jmpt.2010.08.022.
The purpose of this study was to investigate the differences in pressure and thermal pain hypersensitivity between patients with acute and chronic neck pain and healthy subjects.
Five patients with acute neck pain, 7 patients with chronic neck pain, and 6 matched controls participated. Pressure pain thresholds (PPTs) were assessed over the supraorbital, infraorbital, mental, median, ulnar, and radial nerves; the C5-C6 zygapophyseal joint; the second metacarpal; and the tibialis anterior muscle by an assessor blinded to the subjects' condition. Head pain threshold and cold pain threshold (CPT) were measured over the cervical region and over the tibialis anterior muscle.
The analysis of variance found significant differences between groups, but not between sides, for PPT over the supraorbital, mental, median, ulnar and radial nerves; the C5-C6 joint; the second metacarpal; and the tibialis anterior muscle: patients with chronic neck pain showed bilateral lower PPTs as compared with controls (P < .01). Patients with acute neck pain also showed lower PPT (P < .01) over the median and ulnar nerves. No significant differences between groups or sides for head pain threshold over the cervical area or the tibialis anterior muscle were found. Significant differences between groups, but not between sides, for CPT over the neck and the tibialis anterior muscles were found: CPT was also reduced in patients with chronic, but not acute, neck pain (P < .01).
We found widespread decreased PPT in patients with chronic, but not acute, mechanical neck pain as compared with controls. Patients with chronic neck pain also showed cold pain hypersensitivity as compared with patients with acute neck pain and controls. These results support the existence of different sensitization mechanisms between patients with acute and chronic mechanical insidious neck pain.
本研究旨在调查急性和慢性颈部疼痛患者与健康受试者之间在压力和热痛超敏反应方面的差异。
五名急性颈部疼痛患者、七名慢性颈部疼痛患者和六名匹配的对照组参与了研究。由对受试者病情不知情的评估者对眶上神经、眶下神经、颏神经、正中神经、尺神经和桡神经；C5-C6关节突关节；第二掌骨；以及胫骨前肌进行压力痛阈（PPT）评估。在颈部区域和胫骨前肌上测量头部痛阈和冷痛阈（CPT）。
方差分析发现，在眶上神经、颏神经、正中神经、尺神经和桡神经；C5-C6关节；第二掌骨；以及胫骨前肌的PPT方面，组间存在显著差异，但两侧之间无显著差异：与对照组相比，慢性颈部疼痛患者双侧PPT较低（P < 0.01）。急性颈部疼痛患者在正中神经和尺神经上也表现出较低的PPT（P < 0.01）。在颈部区域或胫骨前肌的头部痛阈方面，未发现组间或两侧之间存在显著差异。在颈部和胫骨前肌的CPT方面，发现组间存在显著差异，但两侧之间无显著差异：慢性颈部疼痛患者（而非急性颈部疼痛患者）的CPT也降低（P < 0.01）。
我们发现，与对照组相比，慢性（而非急性）机械性颈部疼痛患者存在广泛的PPT降低。与急性颈部疼痛患者和对照组相比，慢性颈部疼痛患者还表现出冷痛超敏反应。这些结果支持急性和慢性机械性隐匿性颈部疼痛患者之间存在不同的致敏机制。
