Skorupska Elżbieta, Rychlik Michał, Pawelec Wiktoria, Bednarek Agata, Samborski Włodzimierz
Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland.
BMC Res Notes. 2014 Sep 9;7:620. doi: 10.1186/1756-0500-7-620.
Varied and complicated etiology of low back pain radiating distally to the extremities is still causing disagreement and controversy around the issue of its diagnosis and treatment. Most clinicians believe that the source of that pain is generally radicular. While some of them postulate the clinical significance of the sacroiliac joint syndrome, others demonstrate that almost one in five people with back pain experience symptoms indicative of the neuropathic pain component. To date, neuropathic involvement has not been completely understood, and different mechanisms are thought to play an important role. It has been established that muscle pain (myofascial pain) e.g. active trigger points from the gluteus minimus, can mimic pain similar to sciatica, especially in the chronic stage. This paper describes patients presenting with radicular sciatica (case one and two) and sciatica-like symptoms (case three). For the first time, intensive short-term vasodilation in the pain area following needle infiltration of the gluteus minimus trigger point was recorded.
Three Caucasian, European women suffering from radicular sciatica (case one and two) and sciatica-like symptoms (case three) at the age of 57, 49 and 47 respectively underwent infrared camera observation during needle infiltration of the gluteus minimus trigger point. The patients were diagnosed by a neurologist; they underwent magnetic resonance imaging, electromyography, neurography and blood test analysis. Apart from that, the patients were diagnosed by a clinician specializing in myofascial pain diagnosis.
In the examined cases, trigger points-related short-term vasodilation was recorded. Confirmation of these findings in a controlled, blinded study would indicate the existence of a link between the pain of sciatica patients (radicular or sciatica-like pain) and the activity of the autonomic nervous system. Further studies on a bigger group of patients are still needed.
下腰部疼痛向远端肢体放射的病因多样且复杂，这在其诊断和治疗问题上仍存在分歧和争议。大多数临床医生认为，这种疼痛的来源通常是神经根性的。虽然有些人假定骶髂关节综合征具有临床意义，但另一些人则表明，几乎五分之一的背痛患者会出现神经性疼痛成分的症状。迄今为止，神经性参与尚未完全被理解，不同的机制被认为起着重要作用。已经证实，肌肉疼痛（肌筋膜疼痛），例如臀小肌的活动性触发点，可模拟类似于坐骨神经痛的疼痛，尤其是在慢性阶段。本文描述了表现为神经根性坐骨神经痛（病例一和病例二）和坐骨神经痛样症状（病例三）的患者。首次记录了在臀小肌触发点进行针渗透后疼痛区域的密集短期血管扩张情况。
三名分别为57岁、49岁和47岁的白种欧洲女性，患有神经根性坐骨神经痛（病例一和病例二）和坐骨神经痛样症状（病例三），在臀小肌触发点进行针渗透期间接受了红外摄像机观察。这些患者由神经科医生进行诊断；他们接受了磁共振成像、肌电图、神经电图和血液测试分析。除此之外，这些患者还由一名专门从事肌筋膜疼痛诊断的临床医生进行诊断。
在所检查的病例中，记录到了与触发点相关的短期血管扩张情况。在一项对照、双盲研究中对这些发现进行证实，将表明坐骨神经痛患者的疼痛（神经根性或坐骨神经痛样疼痛）与自主神经系统活动之间存在联系。仍需要对更大规模的患者群体进行进一步研究。
