University Department of Anaesthesiology and Pain Therapy, Bern University Hospital, Inselspital, Bern, Switzerland Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland CTU Bern, Bern University Hospital, Inselspital, Bern, Switzerland Pain Unit, Clinic Wilhelm Schulthess, Zurich, Switzerland Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Denmark.
Pain. 2012 Oct;153(10):2083-2091. doi: 10.1016/j.pain.2012.06.025. Epub 2012 Jul 28.
Low back pain is associated with plasticity changes and central hypersensitivity in a subset of patients. We performed a case-control study to explore the discriminative ability of different quantitative sensory tests in distinguishing between 40 cases with chronic low back pain and 300 pain-free controls, and to rank these tests according to the extent of their association with chronic pain. Gender, age, height, weight, body mass index, and psychological measures were recorded as potential confounders. We used 26 quantitative sensory tests, including different modalities of pressure, heat, cold, and electrical stimulation. As measures of discrimination, we estimated receiver operating characteristics (ROC) and likelihood ratios. Six tests seemed useful (in order of their discriminative ability): (1) pressure pain detection threshold at the site of most severe pain (fitted area under the ROC, 0.87), (2) single electrical stimulation pain detection threshold (0.87), (3) single electrical stimulation reflex threshold (0.83), (4) pressure pain tolerance threshold at the site of most severe pain (0.81), (5) pressure pain detection threshold at suprascapular region (0.80), and (6) temporal summation pain threshold (0.80). Pressure and electrical pain modalities seemed most promising and may be used for diagnosis of pain hypersensitivity and potentially for identifying individuals at risk of developing chronic low back pain over time.
腰痛与部分患者的可塑性变化和中枢敏化有关。我们进行了一项病例对照研究，以探索不同定量感觉测试在区分 40 例慢性腰痛患者和 300 例无痛对照者方面的鉴别能力，并根据这些测试与慢性疼痛的关联程度对其进行排序。性别、年龄、身高、体重、体重指数和心理测量被记录为潜在的混杂因素。我们使用了 26 种定量感觉测试，包括不同模式的压力、热、冷和电刺激。作为区分措施，我们估计了接收器操作特性（ROC）和似然比。六项测试似乎有用（按其区分能力排序）：（1）最严重疼痛部位的压痛检测阈值（ROC 下拟合面积，0.87），（2）单次电刺激疼痛检测阈值（0.87），（3）单次电刺激反射阈值（0.83），（4）最严重疼痛部位的压痛耐受阈值（0.81），（5）肩胛上区压痛检测阈值（0.80），和（6）时间总和疼痛阈值（0.80）。压力和电痛模式似乎最有希望，可用于诊断疼痛敏化，并可能用于识别随着时间推移有发展为慢性腰痛风险的个体。
