腰椎退变性慢性疼痛综合征各种诊断策略的潜在影响。

The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration.

机构信息

Scientific Research Institute of Traumatology and Orthopedics, Nizhniy Novgorod, Russian Federation.

出版信息

J Pain Res. 2013 Apr 17;6:289-96. doi: 10.2147/JPR.S42646. Print 2013.

DOI:10.2147/JPR.S42646

PMID:23637553

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3636805/

Abstract

PURPOSE

To study the possible effects of various diagnostic strategies and the relative contribution of various structures in order to determine the optimal diagnostic strategy in treating patients with noncompressive pain syndromes.

STUDY DESIGN

Prospective, nonrandomized cohort study of 83 consecutive patients with noncompressive pain syndromes resistant to repeated courses of conservative treatment. The follow-up period was 18 months.

RESULTS

Nucleoplasty was effective in cases of discogenic pain; the consequences related to false positive results of the discography were significant. The most specific criterion was 80% pain relief after facet joint blocks, whereas 50% pain relief and any subjective pain relief were not associated with a significant increase in the success rate. A considerable rate of false negative results was associated with 80% pain relief, whereas 50% pain relief after facet joint blocks showed the optimal ratio of sensitivity and specificity. Facet joint pain was detected in 50.6% of cases (95% confidence interval 44.1%-66.3%), discogenic pain in 16.9% cases (95% confidence interval 9.5%-26.7%), and sacroiliac joint pain in 7.2% cases (95% confidence interval 2.7%-15%). It was impossible to differentiate the main source of pain in 25.3% of cases.

CONCLUSION

It is rational to adjust the diagnostic algorithm to the probability of detecting a particular pain source and, in doing so, reduce the number of invasive diagnostic measures to evaluate a pain source. False positive results of diagnostic measures can negatively affect the overall efficacy of a particular technology; therefore, all reasons for the failure should be studied in order to reach an unbiased conclusion. In choosing diagnostic criteria, not only should the success rate of a particular technology be taken into consideration but also the rate of false negative results. Acceptable diagnostic criteria should be based on a rational balance of sensitivity and specificity.

摘要

目的

研究各种诊断策略的可能效果和各种结构的相对贡献，以确定治疗非压迫性疼痛综合征患者的最佳诊断策略。

研究设计

对 83 例非压迫性疼痛综合征患者进行前瞻性、非随机队列研究，这些患者对多次保守治疗均无反应。随访时间为 18 个月。

结果

椎间盘成形术对椎间盘源性疼痛有效；椎间盘造影术假阳性结果的后果显著。最特异的标准是关节突关节阻滞 80%疼痛缓解，而 50%疼痛缓解和任何主观疼痛缓解与成功率的显著增加无关。相当比例的假阴性结果与 80%疼痛缓解相关，而关节突关节阻滞 50%疼痛缓解显示出最佳的敏感性和特异性比值。在 50.6%的病例中发现关节突关节疼痛（95%置信区间为 44.1%-66.3%），16.9%的病例发现椎间盘源性疼痛（95%置信区间为 9.5%-26.7%），7.2%的病例发现骶髂关节疼痛（95%置信区间为 2.7%-15%）。在 25.3%的病例中，无法区分疼痛的主要来源。

结论

根据检测特定疼痛源的可能性调整诊断算法是合理的，并由此减少评估疼痛源的侵入性诊断措施的数量。诊断措施的假阳性结果可能会对特定技术的整体疗效产生负面影响；因此，应研究所有失败的原因，以得出公正的结论。在选择诊断标准时，不仅要考虑特定技术的成功率，还要考虑假阴性结果的发生率。可接受的诊断标准应基于合理的敏感性和特异性平衡。