Fernández-de-Las-Peñas César, Ortega-Santiago Ricardo, Ortíz-Gutiérrez Rosa, Caminero Ana B, Salom-Moreno Jaime, Arendt-Nielsen Lars
*Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón §Department of Physical Therapy, Universidad Antonio de Nebrija †Laboratory of Esthesiology, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid ∥Department of Neurology, Hospital Nuestra Señora de Sonsoles, Avila, Spain ‡Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark.
Clin J Pain. 2015 Jan;31(1):66-72. doi: 10.1097/AJP.0000000000000084.
To determine the presence of widespread pressure hyperalgesia in multiple sclerosis (MS) patients with and without pain and its association with pain and fatigue.
A total of 108 individuals with definite MS, 49 men and 59 women (mean age, 44±8 y) and 108 age-matched and sex-matched pain-free controls (mean age, 44±9 y) were included. Fifty patients (n=58, 54%) reported pain and 50 (46%) did not. Pressure pain threshold (PPT) was bilaterally assessed over supraorbital, infraorbital, mental, median, radial and ulnar nerve trunks, C5-C6 joint, second metacarpal, and tibialis anterior muscle by an assessor blinded to the patient's condition. The intensity of pain was assessed with a numerical pain rate scale (0 to 10), fatigue was determined with the Fatigue Impact Scale, and depression was evaluated with the Beck Depression Inventory.
The analyses of covariance revealed that PPT were significantly decreased bilaterally over the supraorbital, infraorbital, mental, median, ulnar and radial nerve trunks, C5-C6 joint, second metacarpal, and tibialis anterior muscles in patients with MS compared with pain-free controls (all, P<0.001). No significant differences existed between MS patients with pain and those without pain (all P>0.944). Patients with pain exhibited higher fatigue and depression than those patients without pain (P<0.05). PPT was not associated with any clinical variable, that is, pain, depression, or fatigue.
Our study found widespread pressure pain hyperalgesia in individuals with MS as compared with pain-free controls. No differences existed between MS patients with pain and those without pain in the presence of widespread pressure sensitivity. Current results suggest that MS is associated with sensory hyperexcitability of the central nervous system or dysfunction in endogenous pain modulatory systems.
确定伴有或不伴有疼痛的多发性硬化症（MS）患者中广泛存在的压力性痛觉过敏情况及其与疼痛和疲劳的关联。
纳入了108例确诊为MS的患者，其中49例男性和59例女性（平均年龄44±8岁），以及108例年龄和性别匹配的无疼痛对照者（平均年龄44±9岁）。50例患者（n = 58，54%）报告有疼痛，50例（46%）无疼痛。由对患者病情不知情的评估者对眶上、眶下、颏部、正中、桡神经和尺神经干、C5 - C6关节、第二掌骨和胫骨前肌进行双侧压力痛阈（PPT）评估。用数字疼痛评分量表（0至10）评估疼痛强度，用疲劳影响量表确定疲劳程度，用贝克抑郁量表评估抑郁情况。
协方差分析显示，与无疼痛对照者相比，MS患者双侧眶上、眶下、颏部、正中、尺神经和桡神经干、C5 - C6关节、第二掌骨和胫骨前肌的PPT显著降低（均P < 0.001）。有疼痛的MS患者和无疼痛的MS患者之间无显著差异（均P > 0.944）。有疼痛的患者比无疼痛的患者表现出更高的疲劳和抑郁程度（P < 0.05）。PPT与任何临床变量，即疼痛、抑郁或疲劳均无关联。
我们的研究发现，与无疼痛对照者相比，MS患者中存在广泛的压力性疼痛痛觉过敏。有疼痛的MS患者和无疼痛的MS患者在广泛压力敏感性方面无差异。当前结果表明，MS与中枢神经系统的感觉过敏或内源性疼痛调节系统功能障碍有关。
