Schäfer Axel G M, Hall Toby M, Rolke Roman, Treede Rolf-Detlef, Lüdtke Kerstin, Mallwitz Joachim, Briffa Kathryn N
HAWK University of Applied Sciences and Arts, Hildesheim, Germany.
School of Physiotherapy, Curtin Innovation Health Research Institute, Curtin University of Technology Perth, Perth, Australia Manual Concepts, Perth, Australia.
J Back Musculoskelet Rehabil. 2014;27(4):409-18. doi: 10.3233/BMR-140461.
Leg pain is associated with back pain in 25-65% of all cases and classified as somatic referred pain or radicular pain. However, distinction between the two may be difficult as different pathomechanisms may cause similar patterns of pain. Therefore a pathomechanism based classification system was proposed, with four distinct hierarchical and mutually exclusive categories: Neuropathic Sensitization (NS) comprising major features of neuropathic pain with sensory sensitization; Denervation (D) arising from significant axonal compromise; Peripheral Nerve Sensitization (PNS) with marked nerve trunk mechanosensitivity; and Musculoskeletal (M) with pain referred from musculoskeletal structures.
To investigate construct validity of the classification system.
Construct validity was investigated by determining the relationship of nerve functioning with subgroups of patients and asymptomatic controls. Thus somatosensory profiles of subgroups of patients with low back related leg pain (LBRLP) and healthy controls were determined by a comprehensive quantitative sensory test (QST) protocol. It was hypothesized that subgroups of patients and healthy controls would show differences in QST profiles relating to underlying pathomechanisms.
77 subjects with LBRLP were recruited and classified in one of the four groups. Additionally, 18 age and gender matched asymptomatic controls were measured. QST revealed signs of pain hypersensitivity in group NS and sensory deficits in group D whereas Groups PNS and M showed no significant differences when compared to the asymptomatic group.
These findings support construct validity for two of the categories of the new classification system, however further research is warranted to achieve construct validation of the classification system as a whole.
在所有病例中，25% - 65%的腿痛与背痛相关，可分为躯体牵涉痛或神经根性疼痛。然而，由于不同的病理机制可能导致相似的疼痛模式，区分两者可能会很困难。因此，有人提出了一种基于病理机制的分类系统，该系统有四个不同的层次且相互排斥的类别：神经病理性敏化（NS），包括具有感觉敏化的神经病理性疼痛的主要特征；失神经支配（D），由明显的轴突损伤引起；周围神经敏化（PNS），具有明显的神经干机械敏感性；以及肌肉骨骼性（M），疼痛源自肌肉骨骼结构。
研究该分类系统的结构效度。
通过确定神经功能与患者亚组和无症状对照组之间的关系来研究结构效度。因此，采用全面的定量感觉测试（QST）方案来确定下背部相关腿痛（LBRLP）患者亚组和健康对照组的体感特征。假设患者亚组和健康对照组在与潜在病理机制相关的QST特征上会存在差异。
招募了77例患有LBRLP的受试者，并将其分为四组之一。此外，对18名年龄和性别匹配的无症状对照组进行了测量。QST显示NS组有疼痛超敏迹象，D组有感觉缺陷，而PNS组和M组与无症状组相比无显著差异。
这些发现支持了新分类系统中两个类别的结构效度，然而，有必要进行进一步研究以实现整个分类系统的结构验证。
