Pain and Anaesthesia Research Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE UK and 2Department of Anaesthesiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Br J Anaesth. 2017 Jun 1;118(6):924-931. doi: 10.1093/bja/aex089.
BACKGROUND.: Quantitative sensory testing (QST) has been used to predict the outcome of epidural steroid injections in lumbosacral radicular pain and has the potential to be an important tool in the selection of appropriate treatment (such as epidural steroid injections vs surgery) for patients with chronic radicular pain. In addition, QST assists in identification of the pain pathways of peripheral and central sensitization in selected groups of patients.
METHODS.: Twenty-three patients were given dorsal root ganglion (DRG) infiltration with local anaesthesia and steroid ('DRG block'), and those who demonstrated at least 50% pain relief were offered pulsed radiofrequency (PRF) to the DRG. Questionnaires and QST scores were measured before the DRG blocks and at 1 week and 3 months after their procedure. Those who received PRF also answered questionnaires and underwent QST measurements at 1 week and 3 months after their procedure.
RESULTS.: There was a significant increase in pressure pain threshold scores after DRG blocks. A reduced conditioned pain modulation response was seen before DRG, which increased after the procedure. Ten out of 23 patients underwent PRF to the DRG, and an increase in pressure pain threshold scores after PRF was observed. The conditioned pain modulation response was maintained in this group and increased after PRF.
CONCLUSIONS.: The study demonstrates that patients with unilateral radicular low back pain who receive dorsal root ganglion interventions show changes in pressure pain thresholds and conditioned pain modulation that are consistent with a 'normalization' of peripheral and central sensitization.
定量感觉测试（QST）已被用于预测腰骶神经根痛硬膜外类固醇注射的结果，并且有可能成为选择慢性根性痛患者适当治疗方法（如硬膜外类固醇注射与手术）的重要工具。此外，QST有助于确定外周和中枢敏化的疼痛途径，在选择的患者群体中。
23 名患者接受背根神经节（DRG）局部麻醉和类固醇浸润（“DRG 阻滞”），那些至少有 50%疼痛缓解的患者接受 DRG 脉冲射频（PRF）治疗。在 DRG 阻滞之前、之后 1 周和 3 个月，以及在接受 PRF 治疗后 1 周和 3 个月，测量问卷调查和 QST 评分。接受 PRF 治疗的患者还在治疗后 1 周和 3 个月时回答问卷并进行 QST 测量。
DRG 阻滞后压力疼痛阈值评分显著增加。DRG 阻滞前可见条件性疼痛调制反应降低，DRG 阻滞后增加。23 名患者中有 10 名接受了 DRG 的 PRF 治疗，PRF 后压力疼痛阈值评分增加。该组的条件性疼痛调制反应保持不变，并在 PRF 后增加。
该研究表明，接受背根神经节干预的单侧神经根性腰痛患者的压力疼痛阈值和条件性疼痛调制发生变化，这与外周和中枢敏化的“正常化”一致。
