Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Nijmegen Medical Centre, The Netherlands.
Reg Anesth Pain Med. 2011 Nov-Dec;36(6):531-6. doi: 10.1097/AAP.0b013e31822e0d4a.
Central sensitization due to visceral pancreatic nociceptive input may be important in chronic pancreatitis pain. We investigated whether bilateral thoracoscopic splanchnicectomy (BTS) to reduce nociceptive input in chronic pancreatitis patients (CPP) with poor pain control affects supraspinal and spinal sensitization.
Seventeen CPP were studied preoperatively and 6 weeks after BTS. Pressure pain thresholds (PPT) were measured in clavicle and pancreatic dermatomes reflecting supraspinal and spinal central sensitization, respectively. Patients with increased PPT after BTS (hypoalgesic) were compared to those without (hyperalgesic) and PPT vs. pain numeric rating scale (NRS) changes compared.
After BTS, ten patients showed C5 PPT increases (hypoalgesic; median change 87 kPa), 7 patients had unaltered/lower PPT (hyperalgesic; -135 kPa). Preoperative pain NRS was similar between groups (4 vs. 5, P = 0.2). After BTS hypoalgesic group NRS was lower (1 vs. 6; P = 0.008) and NRS change greater (-2 vs. 0; P = 0.005). Whole group NRS and C5 PPT change correlated significantly and negatively (r = 0.53; P < 0.05), but not for pancreatic PPT.
Reduced supraspinal-but not spinal-central sensitization after BTS was associated with significantly reduced pain scores in a majority of CPP. A subgroup showed no reductions in supraspinal central sensitization after BTS, coupled to no significant pain NRS reduction. Our results suggest that a subgroup of CPP has altered pain processing that may be independent of ongoing peripheral nociceptive input, resulting in persisting pain despite BTS. If confirmed, these results indicate the importance of sensory testing for indications and management of pain treatments.
内脏胰腺传入的伤害感受敏化可能在慢性胰腺炎疼痛中起重要作用。我们研究了双侧胸腔镜内脏神经切断术（BTS）是否会减少慢性胰腺炎患者（CPP）的疼痛传入，从而影响中枢敏化。
17 例 CPP 患者在术前和 BTS 后 6 周进行研究。分别在锁骨和胰腺皮区测量压力疼痛阈值（PPT），以反映中枢敏化的脊髓和脊髓上水平。将 BTS 后 PPT 升高的患者（低敏组）与未升高的患者（高敏组）进行比较，并比较 PPT 与疼痛数字评分量表（NRS）的变化。
BTS 后，10 例患者 C5 PPT 升高（低敏组，平均变化 87kPa），7 例患者 PPT 不变或降低（高敏组，-135kPa）。两组术前疼痛 NRS 相似（4 与 5，P=0.2）。BTS 后低敏组 NRS 降低（1 与 6；P=0.008），NRS 变化更大（-2 与 0；P=0.005）。全组 NRS 和 C5 PPT 变化呈显著负相关（r=0.53；P<0.05），但与胰腺 PPT 无关。
BTS 后脊髓上而非脊髓中枢敏化的降低与大多数 CPP 的疼痛评分显著降低相关。一小部分 CPP 患者 BTS 后脊髓上中枢敏化没有降低，疼痛 NRS 也没有显著降低。我们的结果表明，一小部分 CPP 的疼痛处理可能发生改变，可能与持续的外周伤害感受输入无关，导致尽管进行了 BTS 仍持续存在疼痛。如果得到证实，这些结果表明感觉测试对于疼痛治疗的适应证和管理很重要。
