Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo, Brazil.
Neurology Division, Department of Neurology, São Paulo State University (Unesp) Medical School, Botucatu, Brazil.
Eur J Pain. 2018 Jan;22(1):72-83. doi: 10.1002/ejp.1091. Epub 2017 Aug 22.
Motor neuron diseases (MND) represent a group of disorders that evolve with inexorable muscle weakness and medical management is based on symptom control. However, deeper characterization of non-motor symptoms in these patients have been rarely reported.
This cross-sectional study aimed to describe non-motor symptoms in MND and their impact on quality of life and functional status, with a focus on pain and sensory changes. Eighty patients (31 females, 55.7 ± 12.9 years old) with MND underwent a neurological examination, pain, mood, catastrophizing and psychophysics assessments [quantitative sensory testing (QST) and conditioned pain modulation (CPM)], and were compared to sex- and age-matched healthy controls (HC).
Chronic pain was present in 46% of patients (VAS =5.18 ± 2.0). Pain of musculoskeletal origin occurred in 40.5% and was mainly located in the head/neck (51%) and lower back (35%). Neuropathic pain was not present in this sample. Compared to HC, MND patients had a lower cold detection threshold (p < 0.002), and significantly lower CPM scores (4.9 ± 0.2% vs. 22.1 ± 0.2%, p = 0.012). QST/CPM results did not differ between MND patients with and without pain. Pain intensity was statistically correlated with anxiety, depression and catastrophism, and spasticity scores were inversely correlated with CPM (ρ = -0.30, p = 0.026).
Pain is frequently reported by patients with MNDs. Somatosensory and CPM changes exist in MNDs and may be related to the neurodegenerative nature of the disease. Further studies should investigate the most appropriate treatment strategies for these patients.
We report a comprehensive evaluation of pain and sensory abnormalities in motor neuron disease (MND) patients. We assessed the different pain syndromes present in MND with validated tools, and described the QST and conditioned pain modulation profiles in a controlled design.
运动神经元病（MND）代表一组以肌肉无力进行性发展为特征的疾病，其医学管理主要基于症状控制。然而，这些患者的非运动症状的更深入特征很少有报道。
这项横断面研究旨在描述 MND 中的非运动症状及其对生活质量和功能状态的影响，重点关注疼痛和感觉变化。80 名 MND 患者（31 名女性，55.7±12.9 岁）接受了神经学检查、疼痛、情绪、灾难化和心理物理学评估[定量感觉测试（QST）和条件性疼痛调制（CPM）]，并与性别和年龄匹配的健康对照组（HC）进行了比较。
46%的患者存在慢性疼痛（VAS=5.18±2.0）。肌肉骨骼来源的疼痛发生在 40.5%，主要位于头部/颈部（51%）和下背部（35%）。该样本中不存在神经病理性疼痛。与 HC 相比，MND 患者的冷觉检测阈值较低（p<0.002），CPM 评分显著较低（4.9±0.2%比 22.1±0.2%，p=0.012）。有无疼痛的 MND 患者的 QST/CPM 结果无差异。疼痛强度与焦虑、抑郁和灾难化呈统计学相关，痉挛评分与 CPM 呈负相关（ρ=-0.30，p=0.026）。
MND 患者常报告疼痛。感觉和 CPM 变化存在于 MND 中，可能与疾病的神经退行性性质有关。进一步的研究应该调查这些患者最合适的治疗策略。
我们报告了对运动神经元病（MND）患者疼痛和感觉异常的全面评估。我们使用经过验证的工具评估了 MND 中存在的不同疼痛综合征，并在对照设计中描述了 QST 和条件性疼痛调制谱。
