Rombaut Lies, Scheper Mark, De Wandele Inge, De Vries Janneke, Meeus Mira, Malfait Fransiska, Engelbert Raoul, Calders Patrick
Department of Rehabilitation Sciences and Physiotherapy, Ghent University-Artevelde University College, De Pintelaan 185, 3B3, 9000, Ghent, Belgium,
Clin Rheumatol. 2015 Jun;34(6):1121-9. doi: 10.1007/s10067-014-2499-0. Epub 2014 Feb 4.
Chronic widespread pain is highly present in patients with the Ehlers-Danlos syndrome hypermobility type (EDS-HT), but up to now, evidence for generalized hyperalgesia is lacking. The aim of this study is to investigate whether pressure pain thresholds (PPTs) at both symptomatic and asymptomatic body areas differ in EDS-HT patients compared to healthy subjects. Twenty-three women with EDS-HT and 23 gender- and age-matched healthy controls participated. All subjects marked on Margolis Pain Diagram where they felt pain lasting longer than 24 h in the past 4 weeks. Then, they completed several questionnaires assessing pain cognitions, fatigue, disability, and general health status, in order to take the possible influence of these factors on PPTs into account. Patients also completed a form concerning the type of pain they experienced. Thereupon, a blinded researcher assessed PPTs at 14 body locations on the trunk and extremities. PPTs were compared for the two complete groups. In addition, PPTs of patients and controls who did not report pain in a respective zone were compared. PPTs of the patients were significantly lower compared to those of the control group, also when pain-free samples per zone were compared. The mean (SD) PPT was 2.9 (1.62) kg/cm(2) in the EDS-HT patients and 5.2 (1.88) kg/cm(2) in the controls (P < 0.001). No confounding factors responsible for the observed differences could be revealed. In half of the patient group, a predominantly neuropathic pain component was likely present. This study provides evidence for the existence of hyperalgesia even in asymptomatic areas (generalized secondary hyperalgesia). The generalized hyperalgesia may represent the involvement of a sensitized central nervous system, which inquires an adapted pain management for this patient group.
慢性广泛性疼痛在埃勒斯-当洛综合征高活动型（EDS-HT）患者中极为常见，但截至目前，尚无全身性痛觉过敏的证据。本研究的目的是调查与健康受试者相比，EDS-HT患者有症状和无症状身体部位的压痛阈值（PPT）是否存在差异。23名患有EDS-HT的女性和23名年龄及性别匹配的健康对照者参与了研究。所有受试者在马戈利斯疼痛图上标记出过去4周内疼痛持续超过24小时的部位。然后，他们完成了几份评估疼痛认知、疲劳、残疾和总体健康状况的问卷，以便考虑这些因素对PPT的可能影响。患者还填写了一份关于他们所经历疼痛类型的表格。随后，一名不知情的研究人员评估了躯干和四肢14个身体部位的PPT。对两个完整组的PPT进行了比较。此外，还比较了在各自区域未报告疼痛的患者和对照者的PPT。与对照组相比，患者的PPT显著更低，在比较每个区域无痛样本时也是如此。EDS-HT患者的平均（标准差）PPT为2.9（1.62）kg/cm²，对照组为5.2（1.88）kg/cm²（P < 0.001）。未发现导致观察到差异的混杂因素。在一半的患者组中，可能主要存在神经性疼痛成分。本研究为即使在无症状区域也存在痛觉过敏（全身性继发性痛觉过敏）提供了证据。全身性痛觉过敏可能代表中枢神经系统致敏，这需要为该患者群体调整疼痛管理方案。
