KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium.
Univeristy of Antwerp, Faculty of medicine and health sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium.
Pain Physician. 2018 May;21(3):E247-E256.
Hypersensitivity of the central nervous system to environmental and chemical stimuli is a clinical feature of central sensitization mechanisms that can be assessed with the central sensitization inventory (CSI).
The aim was to determine prevalence rate of this feature and explore the treatment-, patient-, pain-, and psychosocial-related variables associated with the degree of self-reported signs of central sensitization, assessed with the CSI (0-100), in breast cancer survivors at long-term.
Cross-sectional study.
University Hospitals, Leuven, Belgium.
One hundred and forty-six women with persistent pain, more than one year after breast cancer surgery, were included. The following factors were analyzed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy, and trastuzumab); 2) patient's related variables (age and body mass index); 3) pain-related variables (pain intensity, pain quality, primary hyperalgesia, and index of widespread pain); and 4) psychosocial variables (the degree of pain catastrophizing and vigilance and awareness to pain). The dependent variable was degree of central sensitization measured with the CSI. Additionally, a stepwise regression was performed.
Fifty-five (38%) patients reported signs of central sensitization measured with the CSI (i.e., > 40/100). From multivariable analysis, it appears that more severe pain quality and higher levels of pain catastrophizing contribute to a higher degree of central sensitization. The stepwise regression revealed that up to 24% of variance of the CSI can be explained by these factors.
A selection bias may be present since patients were all recruited from a larger cohort participating in clinical trials on the effectiveness of physical therapy after breast cancer treatment.
Signs of central sensitization cannot be neglected in breast cancer survivors at long term. More severe pain quality and pain catastrophizing contribute to higher levels of central sensitization in this population.
Breast neoplasm, pain, central sensitization mechanisms, central sensitization inventory.
中枢神经系统对环境和化学刺激的敏感性是中枢敏化机制的一个临床特征，可以用中枢敏化量表（CSI）进行评估。
旨在确定该特征的患病率，并探讨与长期乳腺癌幸存者自我报告的中枢敏化迹象程度相关的治疗、患者、疼痛和心理社会相关变量，这些变量用 CSI（0-100）进行评估。
横断面研究。
比利时鲁汶大学医院。
纳入 146 名乳腺癌手术后持续疼痛超过 1 年的女性。通过单变量和多变量分析，分析以下因素：1）治疗相关变量（手术类型、淋巴结清扫水平、放疗、化疗、激素治疗和曲妥珠单抗）；2）患者相关变量（年龄和体重指数）；3）疼痛相关变量（疼痛强度、疼痛质量、原发性痛觉过敏和广泛疼痛指数）；4）心理社会变量（疼痛灾难化和对疼痛的警觉和意识程度）。依赖变量是用 CSI 测量的中枢敏化程度。此外，还进行了逐步回归。
55 名（38%）患者报告有 CSI（即>40/100）测量的中枢敏化迹象。多变量分析显示，更严重的疼痛质量和更高水平的疼痛灾难化会导致更高程度的中枢敏化。逐步回归显示，这些因素可以解释 CSI 变异的 24%。
可能存在选择偏倚，因为所有患者均来自于更大的队列，该队列参与了乳腺癌治疗后物理治疗效果的临床试验。
在长期的乳腺癌幸存者中，不能忽视中枢敏化的迹象。更严重的疼痛质量和疼痛灾难化会导致该人群的中枢敏化程度更高。
乳腺肿瘤，疼痛，中枢敏化机制，中枢敏化量表。
