Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea.
Pain Physician. 2013 Nov-Dec;16(6):E715-23.
Given that there are gender differences in pain perception, it is likely that there are differences in pain responses between men and women with lumbar spinal stenosis (LSS). Furthermore, these differences may lead to different degrees of impairment in both daily activities and quality of life between men and women.
To elucidate the difference of LSS symptom severity between genders in relation to pain sensitivity.
Retrospective analysis of prospectively collected data.
A total of 160 patients who had symptomatic degenerative lumbar spinal stenosis completed a series of questionnaires on their first visit in the outpatient clinic, including a pain sensitivity questionnaire (PSQ) (total PSQ and PSQ-minor), Oswestry Disability Index (ODI), visual analog scale (VAS) for back pain, and Short Form-36 (SF-36). Using magnetic resonance images, the degree of canal stenosis and disc degeneration were graded based on the method by Schizas and the Pfirrmann classification, respectively. Symptom severity, pain sensitivity, and radiologic findings were compared between men and women. In each gender group analysis, the correlation between pain sensitivity and symptom severity was analyzed.
After adjustment for age and the grade of disc degeneration, the pain sensitivity represented by total PSQ and PSQ-minor was significantly higher in women than in men. Moreover, there was a higher VAS for back pain/leg pain and ODI in women compared to men after adjustment for body mass index (BMI), age, and the grades of canal stenosis and disc degeneration. After additional adjustment for pain sensitivity including total PSQ and PSQ-minor, there was no difference in VAS for back pain/leg pain between genders. On the SF-36 women demonstrated a lower quality of life than men in terms of Physical Function, Role Physical, Bodily Pain, General Health, and Physical Component Summary. Each gender group analysis showed that pain sensitivity was associated with symptom severity and disability caused by LSS in both women and men.
The present study did not evaluate psychological factors including catastrophizing and/or undiagnosed personal traits which possibly can influence the severity of symptoms from LSS.
Women showed increased low back pain and leg pain due to degenerative LSS compared to men. The current study demonstrates that this difference in symptom severity may be partly mediated by pain sensitivity.
鉴于疼痛感知存在性别差异，男性和女性腰椎管狭窄症（LSS）患者的疼痛反应可能存在差异。此外，这些差异可能导致男性和女性在日常生活活动和生活质量方面的受损程度不同。
阐明与疼痛敏感性相关的 LSS 症状严重程度在性别之间的差异。
前瞻性收集数据的回顾性分析。
共有 160 名患有症状性退行性腰椎管狭窄症的患者在门诊就诊时完成了一系列问卷，包括疼痛敏感性问卷（PSQ）（总 PSQ 和 PSQ-小）、Oswestry 残疾指数（ODI）、腰背疼痛视觉模拟评分（VAS）和简明健康调查问卷 36 项（SF-36）。使用磁共振成像，根据 Schizas 方法和 Pfirrmann 分级分别对椎管狭窄程度和椎间盘退变程度进行分级。比较男性和女性之间的症状严重程度、疼痛敏感性和影像学发现。在每个性别组分析中，分析疼痛敏感性与症状严重程度之间的相关性。
在校正年龄和椎间盘退变程度后，女性的总 PSQ 和 PSQ-小代表的疼痛敏感性明显高于男性。此外，在校正体重指数（BMI）、年龄以及椎管狭窄和椎间盘退变程度的等级后，女性的腰背疼痛/腿痛 VAS 和 ODI 均高于男性。在校正包括总 PSQ 和 PSQ-小在内的疼痛敏感性后，男女之间的腰背疼痛/腿痛 VAS 无差异。在 SF-36 中，女性在身体功能、身体角色、身体疼痛、一般健康和身体成分综合方面的生活质量均低于男性。每个性别组分析均表明，疼痛敏感性与女性和男性的 LSS 症状严重程度和残疾相关。
本研究未评估心理因素，包括可能影响 LSS 症状严重程度的灾难化和/或未确诊的个人特征。
与男性相比，女性由于退行性 LSS 而出现更严重的腰背疼痛和腿痛。本研究表明，这种症状严重程度的差异可能部分由疼痛敏感性介导。
