*School of Physiotherapy, Curtin Health Innovation Research Institute, Curtin University Departments of †Physiotherapy ‡Neurosurgery, Sir Charles Gairdner Hospital, Perth §Pain Medicine Unit, Fremantle Hospital and Health Service, Fremantle, WA, Australia.
Clin J Pain. 2013 Oct;29(10):846-56. doi: 10.1097/AJP.0b013e318278d434.
The aim of this study was to investigate, using quantitative sensory testing (QST) parameters and the painDETECT (PD-Q) screening questionnaire, the presence of neuropathic pain (NeP) in patients with unilateral painful cervical radiculopathy (CxRAD) and in patients with unilateral nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP).
All patients completed the PD-Q before QST. QST was performed bilaterally in the maximal pain area and the affected dermatome in 23 patients with painful C6 or C7 radiculopathy and in 8 patients with NSNAP following a C6/7 dermatomal pain distribution.
Patients with CxRAD demonstrated a significant loss of sensory function in mechanical (P≤0.021) and vibration sense (P≤0.003) on the symptomatic side compared with the asymptomatic side in both tested body regions and in the dermatome reduced cold detection (P=0.021) and pressure pain sensitivity (P=0.005), findings consistent with nerve root damage. These sensory alterations in the maximal pain area/symptomatic side are confirmative for the presence of NeP. In contrast to these QST data, only 30% of patients with CxRAD demonstrated a NeP component according to the PD-Q score. In patients with NSNAP, a significant side-to-side difference was demonstrated for warm detection threshold in the dermatome (P=0.030). The PD-Q score indicated that NeP components were unlikely in this group.
QST data suggest that NeP is likely to be observed in patients with painful CxRAD, but not in patients with NSNAP.
本研究旨在通过定量感觉测试（QST）参数和疼痛 DETECT（PD-Q）筛查问卷，调查单侧颈神经根病变（CxRAD）伴神经机械感觉过敏（NSNAP）的单侧非特异性颈臂痛患者是否存在神经病理性疼痛（NeP）。
所有患者在 QST 前均完成 PD-Q。在 23 例 C6 或 C7 神经根病变伴疼痛的患者和 8 例 C6/7 皮节疼痛分布的 NSNAP 患者中，双侧在最大疼痛区和受累皮区进行 QST。
与双侧无症状区相比，CxRAD 患者在双侧测试区和皮区的机械（P≤0.021）和振动觉（P≤0.003）均表现出显著的感觉功能丧失，冷觉检测（P=0.021）和压痛敏度（P=0.005）均降低，这些发现与神经根损伤一致。最大疼痛区/症状侧的这些感觉改变可证实 NeP 的存在。与 QST 数据相反，根据 PD-Q 评分，仅有 30%的 CxRAD 患者表现出 NeP 成分。在 NSNAP 患者中，皮区的温觉检测阈值存在显著的双侧差异（P=0.030）。PD-Q 评分表明该组患者不太可能存在 NeP 成分。
QST 数据表明，CxRAD 疼痛患者可能存在 NeP，但 NSNAP 患者不存在。
