间质性膀胱炎/膀胱疼痛综合征中对机械刺激的节段性痛觉过敏：中枢敏化的证据
Segmental hyperalgesia to mechanical stimulus in interstitial cystitis/bladder pain syndrome: evidence of central sensitization.
作者信息
Lai H Henry, Gardner Vivien, Ness Timothy J, Gereau Robert W
机构信息
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri.
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
出版信息
J Urol. 2014 May;191(5):1294-9. doi: 10.1016/j.juro.2013.11.099. Epub 2013 Dec 6.
PURPOSE
We investigate if subjects with interstitial cystitis/bladder pain syndrome demonstrate mechanical or thermal hyperalgesia, and whether the hyperalgesia is segmental or generalized (global).
MATERIALS AND METHODS
Ten female subjects with interstitial cystitis/bladder pain syndrome and 10 age matched female controls without comorbid fibromyalgia or narcotic use were recruited for quantitative sensory testing. Using the method of limits, pressure pain and heat pain thresholds were measured. Using the method of fixed stimulus, the visual analog scale pain experienced was recorded when a fixed pressure/temperature was applied.
RESULTS
The visual analog scale pain rated by female subjects with interstitial cystitis/bladder pain syndrome was significantly higher than that rated by female control subjects when a fixed mechanical pressure (2 or 4 kg) was applied to the suprapubic (T11) area (p = 0.028). There was an up shift of the stimulus-response curve, which corresponded to the presence of mechanical hyperalgesia in the suprapubic area in interstitial cystitis/bladder pain syndrome. However, the visual analog scale pain rated by subjects with interstitial cystitis/bladder pain syndrome was not different from that rated by controls when a fixed pressure was applied at the other body sites (T1 arm, L4 leg, S2-3 sacral). No difference in visual analog scale pain rating was noted when a fixed heat stimulus (35C or 37C) was applied to any of the body sites tested (T1, T11, L4, S2). There was no difference in pressure pain thresholds or thermal pain thresholds between subjects with interstitial cystitis/bladder pain syndrome and controls.
CONCLUSIONS
Female subjects with interstitial cystitis/bladder pain syndrome showed segmental hyperalgesia to mechanical pressure stimulation in the suprapubic area (T10-T12). This segmental hyperalgesia may be explained in part by spinal central sensitization.
目的
我们研究间质性膀胱炎/膀胱疼痛综合征患者是否表现出机械性或热痛觉过敏，以及这种痛觉过敏是节段性还是全身性的。
材料与方法
招募10名患有间质性膀胱炎/膀胱疼痛综合征的女性受试者和10名年龄匹配、无纤维肌痛或未使用麻醉剂的女性对照者进行定量感觉测试。采用极限法测量压力痛阈值和热痛阈值。采用固定刺激法，在施加固定压力/温度时记录视觉模拟量表评分的疼痛感受。
结果
当对耻骨上（T11）区域施加固定机械压力（2或4千克）时，间质性膀胱炎/膀胱疼痛综合征女性受试者的视觉模拟量表评分显著高于女性对照受试者（p = 0.028）。刺激 - 反应曲线出现上移，这与间质性膀胱炎/膀胱疼痛综合征患者耻骨上区域存在机械性痛觉过敏相一致。然而，当在其他身体部位（T1臂、L4腿、S2 - 3骶部）施加固定压力时，间质性膀胱炎/膀胱疼痛综合征患者的视觉模拟量表评分与对照者无异。当对任何测试身体部位（T1、T-11、L4、S2）施加固定热刺激（35℃或37℃）时，视觉模拟量表评分无差异。间质性膀胱炎/膀胱疼痛综合征患者与对照者之间的压力痛阈值或热痛阈值无差异。
结论
患有间质性膀胱炎/膀胱疼痛综合征的女性受试者在耻骨上区域（T10 - T12）对机械压力刺激表现出节段性痛觉过敏。这种节段性痛觉过敏可能部分由脊髓中枢敏化来解释。
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