Schilder Andreas, Hoheisel Ulrich, Magerl Walter, Benrath Justus, Klein Thomas, Treede Rolf-Detlef
Chair of Neurophysiology, Centre for Biomedicine and Medical Technology (CBTM), Medical Faculty Mannheim, Heidelberg University, Germany Department of Anesthesiology and Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg University, Germany Mundipharma Research GmbH & Co. KG, Höhenstraβe 10, Limburg (Lahn), Germany.
Pain. 2014 Feb;155(2):222-231. doi: 10.1016/j.pain.2013.09.025. Epub 2013 Sep 26.
Injection of hypertonic saline into deep tissues of the back (subcutis, muscle, or the surrounding fascia) can induce acute low back pain (LBP). So far, no study has analyzed differences in temporal, qualitative, and spatial pain characteristics originating from these tissues. The current study aimed to investigate the role of the thoracolumbar fascia as a potential source of LBP. In separate sessions, 12 healthy subjects received ultrasound-guided bolus injections of isotonic saline (0.9%) or hypertonic saline (5.8%) into the erector spinae muscle, the thoracolumbar fascia (posterior layer), and the overlying subcutis. Subjects were asked to rate pain intensity, duration, quality, and spatial extent. Pressure pain thresholds were determined pre and post injection. Injections of hypertonic saline into the fascia resulted in significantly larger area under the curve of pain intensity over time than injections into subcutis (P<0.01) or muscle (P<0.001), primarily based on longer pain durations and, to a lesser extent, on higher peak pain ratings. Pressure hyperalgesia was only induced by injection of hypertonic saline into muscle, but not fascia or subcutis. Pain radiation and pain affect evoked by fascia injection exceeded those of the muscle (P<0.01) and the subcutis significantly (P<0.05). Pain descriptors after fascia injection (burning, throbbing, and stinging) suggested innervation by both A- and C-fiber nociceptors. These findings show that the thoracolumbar fascia is the deep tissue of the back that is most sensitive to chemical stimulation, making it a prime candidate to contribute to nonspecific LBP but not to localized pressure hyperalgesia.
向背部深层组织（皮下组织、肌肉或周围筋膜）注射高渗盐水可诱发急性下腰痛（LBP）。到目前为止，尚无研究分析源自这些组织的疼痛在时间、性质和空间特征上的差异。本研究旨在探讨胸腰筋膜作为LBP潜在来源的作用。在不同的时间段，12名健康受试者接受了超声引导下向竖脊肌、胸腰筋膜（后层）及上方皮下组织注射等渗盐水（0.9%）或高渗盐水（5.8%）。受试者被要求对疼痛强度、持续时间、性质和空间范围进行评分。在注射前后测定压力痛阈。向筋膜内注射高渗盐水导致疼痛强度随时间变化的曲线下面积显著大于向皮下组织（P<0.01）或肌肉内注射（P<0.001），这主要基于更长的疼痛持续时间，在较小程度上也基于更高的疼痛峰值评分。压力性痛觉过敏仅由向肌肉内注射高渗盐水诱发，而向筋膜或皮下组织注射则不会诱发。筋膜注射诱发的疼痛放射和疼痛影响超过肌肉注射（P<0.01），且显著超过皮下组织注射（P<0.05）。筋膜注射后的疼痛描述词（灼痛、搏动性痛和刺痛）提示A纤维和C纤维伤害感受器均有神经支配。这些发现表明，胸腰筋膜是背部对化学刺激最敏感的深层组织，使其成为非特异性LBP的主要潜在原因，但不是局部压力性痛觉过敏的原因。
