Rebbeck Trudy, Moloney Niamh, Azoory Roxanne, Hübscher Markus, Waller Robert, Gibbons Rebekah, Beales Darren
T. Rebbeck, PhD, FACP, MAppSc(ManipPhty), BAppSc(Phty), Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, C43A Cumberland Campus, New South Wales 2006, Australia.
N. Moloney, PhD, MManipTher, BPhysio(Hons), Department of Health Professions, Faculty of Medicine, Macquarie University, Sydney, Australia.
Phys Ther. 2015 Nov;95(11):1536-46. doi: 10.2522/ptj.20140352. Epub 2015 May 28.
BACKGROUND: Correlations between clinical and quantitative measures of pain sensitivity are poor, making it difficult for clinicians to detect people with pain sensitivity. Clinical detection of pain sensitivity is important because these people have a different prognosis and may require different treatment. OBJECTIVE: The purpose of this study was to investigate the relationship between clinical and quantitative measures of pain sensitivity across individuals with and without neck pain. METHODS: This cross-sectional study included 40 participants with chronic neck pain and 40 age- and sex-matched controls. Participants underwent quantitative sensory testing of cold pain thresholds (CPTs) and pressure pain thresholds (PPTs). Clinical tests for pain sensitivity were the ice pain test and the pressure pain test. All tests were undertaken at standardized local (neck and upper trapezius muscles) and remote (wrist and tibialis anterior muscles) sites. Median and interquartile range (IQR) were calculated for neck pain and control groups, and parametric and nonparametric tests were used to compare groups. Correlation coefficients were calculated between quantitative and clinical measures. RESULTS: There were significant differences for clinical and quantitative measures of cold and pressure sensitivity between the neck pain and control groups (eg, CPT neck pain group: median=22.31°C, IQR=18.58°C; control group: median=5.0°C, IQR=0.74°C). Moderate-to-good correlations were found between the clinical ice pain test and CPT at all sites (.46 to .68) except at the wrist (.29 to .40). Fair correlations were found for the clinical pressure pain test and PPT (-.26 to -.45). Psychological variables contributing to quantitative measures of pain sensitivity included catastrophization, sleep quality, and female sex. LIMITATIONS: Clinical pressure pain tests were not quantitatively standardized in this study. CONCLUSIONS: The ice pain test may be useful as a clinical correlate of CPT at all sites except the wrist, whereas the pressure pain test is less convincing as a clinical correlate of PPT.
背景：疼痛敏感性的临床测量与定量测量之间的相关性较差，这使得临床医生难以检测出疼痛敏感的人群。疼痛敏感性的临床检测很重要，因为这些人的预后不同，可能需要不同的治疗。 目的：本研究旨在调查有和没有颈部疼痛的个体中疼痛敏感性的临床测量与定量测量之间的关系。 方法：这项横断面研究包括40名慢性颈部疼痛患者和40名年龄及性别匹配的对照组。参与者接受了冷痛阈值（CPT）和压痛阈值（PPT）的定量感觉测试。疼痛敏感性的临床测试为冰痛测试和压痛测试。所有测试均在标准化的局部（颈部和上斜方肌）和远处（手腕和胫骨前肌）部位进行。计算颈部疼痛组和对照组的中位数和四分位间距（IQR），并使用参数检验和非参数检验比较两组。计算定量测量与临床测量之间的相关系数。 结果：颈部疼痛组和对照组在冷觉和压痛敏感性的临床测量与定量测量方面存在显著差异（例如，颈部疼痛组CPT：中位数=22.31°C，IQR=18.58°C；对照组：中位数=5.0°C，IQR=0.74°C）。除手腕部位外（.29至.40），临床冰痛测试与所有部位的CPT之间均发现中度至良好的相关性（.46至.68）。临床压痛测试与PPT之间的相关性一般（-.26至-.45）。导致疼痛敏感性定量测量的心理变量包括灾难化、睡眠质量和女性性别。 局限性：本研究中临床压痛测试未进行定量标准化。 结论：除手腕部位外，冰痛测试可能作为所有部位CPT的临床相关指标，而压痛测试作为PPT的临床相关指标则不太有说服力。
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