From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia.
Neurology. 2018 Sep 4;91(10):e931-e938. doi: 10.1212/WNL.0000000000006120. Epub 2018 Aug 1.
To characterize the pain-related somatosensory and psychological presentation of very early acute patients with a mild traumatic brain injury (mTBI).
Patients with an mTBI participated in a prospective observational study undergoing clinical, psychophysic, and psychological assessment within 72 hours after the accident. Healthy controls underwent similar protocol.
One hundred acute patients with an mTBI (age 36 ± 12.5 [SD] years, range 19-67 years, 42 women) and 80 healthy controls (age 43 ± 14.3 years, range 24-74 years, 40 women) participated. Patients with an mTBI demonstrated a pronociceptive psychophysic response in most tests such as less efficient pressure-pain threshold-conditioned pain modulation (0.19 ±0.19±.09 vs. 0.91±.10 kg, < 0.001) and lower temperature needed to elicit a Pain50 response (44.72 ± 0.26°C vs 46.41 ± 0.30°C, < 0.001). Their psychophysic findings correlated with clinical pain measures, e.g., Pain50 temperature and mean head ( = -0.21, = 0.045) and neck ( = -0.26, = 0.011) pain. The pain-catastrophizing magnification subscale was the only psychological variable to show a difference from the controls, while no significant correlations were found between any psychological measures and the clinical or psychophysic pain measures.
There appears to be a dichotomy between somatosensory and psychological findings in the very early acute post-mTBI stage; while the first is altered and is associated with the clinical picture, the second is unchanged. In the context of the ongoing debate on the pathophysiologic nature of the post-mTBI syndrome, our findings support its "physical" basis, free of mental influence, at least in the short time window after the injury.
描述轻度创伤性脑损伤（mTBI）早期急性患者的疼痛相关躯体感觉和心理表现。
mTBI 患者在事故后 72 小时内接受临床、心理生理和心理评估的前瞻性观察性研究。健康对照组接受类似方案。
100 名 mTBI 急性患者（年龄 36±12.5[SD]岁，范围 19-67 岁，42 名女性）和 80 名健康对照组（年龄 43±14.3 岁，范围 24-74 岁，40 名女性）参与了研究。mTBI 患者在大多数测试中表现出促痛的心理生理反应，例如压力-疼痛阈值条件性疼痛调制效率降低（0.19±0.19±0.09 对 0.91±0.10kg，<0.001）和引起 Pain50 反应所需的较低温度（44.72±0.26°C 对 46.41±0.30°C，<0.001）。他们的心理生理发现与临床疼痛测量相关，例如 Pain50 温度和头部（ =-0.21， =0.045）和颈部（ =-0.26， =0.011）疼痛的平均值。疼痛灾难化放大子量表是唯一与对照组有差异的心理变量，而任何心理测量与临床或心理生理疼痛测量之间均无显著相关性。
在 mTBI 后早期急性阶段，躯体感觉和心理发现之间似乎存在二分法；虽然第一个发生改变并与临床症状相关，但第二个保持不变。在关于 mTBI 后综合征病理生理性质的持续争论中，我们的研究结果支持其“躯体”基础，不受精神影响，至少在受伤后的短期时间窗口内是这样。
