De Kooning Margot, Daenen Liesbeth, Roussel Nathalie, Cras Patrick, Buyl Ronald, Ickmans Kelly, Struyf Filip, Nijs Jo
Pain in Motion Research Group, Departments of Human Physiology and Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium;
J Rehabil Res Dev. 2015;52(4):431-40. doi: 10.1682/JRRD.2014.06.0154.
Patients with acute whiplash-associated disorder (WAD) demonstrate an inefficient endogenous pain inhibition and may experience a dysfunction in autonomic nervous system reactivity to pain. This study compared the autonomic response to painful stimuli between patients with acute and chronic WAD and healthy controls. In addition, the role of the autonomic nervous system for explaining inefficient endogenous pain inhibition was examined in acute WAD. Seventeen patients with acute WAD, 30 patients with chronic WAD, and 31 healthy controls participated in an experiment evaluating the autonomic nervous system at rest and during painful stimuli. Skin conductance and heart rate variability (HRV) parameters were monitored continuously during conditioned pain modulation. A significant autonomic response to pain was present for skin conductance and two HRV parameters in all experimental groups. There was an interaction effect in the skin conductance response to pain but not in HRV responses in any of the groups. In patients with acute WAD, no significant correlations were present between pain, pressure pain thresholds, pain inhibition, and any of the autonomic parameters. This study refutes autonomic dysfunction at rest and in response to pain in acute WAD. The dysfunctional conditioned pain modulation appears unrelated to autonomic responses to pain.
急性挥鞭样损伤相关疾病（WAD）患者表现出内源性疼痛抑制效率低下，并且在自主神经系统对疼痛的反应中可能存在功能障碍。本研究比较了急性和慢性WAD患者与健康对照者对疼痛刺激的自主反应。此外，还研究了自主神经系统在解释急性WAD中内源性疼痛抑制效率低下方面的作用。17例急性WAD患者、30例慢性WAD患者和31名健康对照者参与了一项评估静息状态和疼痛刺激期间自主神经系统的实验。在条件性疼痛调制过程中持续监测皮肤电导和心率变异性（HRV）参数。所有实验组的皮肤电导和两个HRV参数对疼痛均有显著的自主反应。在皮肤电导对疼痛的反应中存在交互作用，但在任何一组的HRV反应中均不存在。在急性WAD患者中，疼痛、压痛阈值、疼痛抑制与任何自主参数之间均无显著相关性。本研究反驳了急性WAD患者静息状态下以及对疼痛反应时存在自主功能障碍的观点。功能失调的条件性疼痛调制似乎与对疼痛的自主反应无关。
