Beales Darren John, Gaynor Odette, Harris Jasmine, Fary Robyn, O'Sullivan Peter Bruce, Slater Helen, Graven-Nielsen Thomas, Palsson Thorvaldur Skuli
School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Scand J Pain. 2019 Jan 28;19(1):53-60. doi: 10.1515/sjpain-2018-0081.
Background and aims For some women, lumbopelvic pain (LPP) developed during pregnancy becomes a continuing post-partum problem. Increased understanding of potential prognostic factors is required. This study investigated whether active straight leg raise (ASLR), sleep dysfunction and pressure pain sensitivity during pregnancy are correlated with LPP intensity and quality, disability, and physical health-related quality of life (HRQoL) post-partum. Methods An exploratory, prospective cohort study design was used. Baseline factors of interest were: (1) ASLR, (2) Pittsburgh Sleep Quality Index, and (3) pressure pain thresholds (PPTs) collected from pregnant women from sites local and distal to the lumbopelvic area. Follow-up data collected 11-18 months post-partum (n=29) were: (1) pain intensity score (numerical rating scale), (2) pain quality (McGill Pain Questionnaire), (3) disability (Pelvic Girdle Questionnaire), and (4) HRQoL (36-item Short Form Health Survey). Correlation analysis was performed. Results Greater difficulty with an ASLR during pregnancy correlated with lower post-partum physical HRQoL scores (r=-0.563, p=0.002). Likewise, reduced PPTs at the sacrum during pregnancy was correlated with a higher post-partum pain quality score (r=-0.384, p=0.040). Conclusions In this cohort, findings indicate that poor ASLR performance and localised pressure pain hypersensitivity at the pelvis during pregnancy are correlated with post-partum physical HRQoL and pain quality, respectively. Implications Pain sensitivity may contribute to the prognosis of women with LPP during pregnancy. These explorative findings may be important for designing larger prognostic studies and may assist in directing potential pain management in post-partum LPP.
背景与目的 对于一些女性而言，孕期出现的腰骶部疼痛（LPP）在产后会持续存在。需要更深入了解潜在的预后因素。本研究调查了孕期主动直腿抬高试验（ASLR）、睡眠功能障碍和压力疼痛敏感性是否与产后LPP的强度和性质、残疾情况以及与身体健康相关的生活质量（HRQoL）相关。方法 采用探索性前瞻性队列研究设计。感兴趣的基线因素包括：（1）ASLR；（2）匹兹堡睡眠质量指数；（3）从腰骶部区域近端和远端部位的孕妇收集的压力疼痛阈值（PPT）。产后11 - 18个月收集的随访数据（n = 29）包括：（1）疼痛强度评分（数字评定量表）；（2）疼痛性质（麦吉尔疼痛问卷）；（3）残疾情况（骨盆带问卷）；（4）HRQoL（36项简短健康调查问卷）。进行相关性分析。结果 孕期ASLR难度越大，与产后身体HRQoL得分越低相关（r = -0.563，p = 0.002）。同样，孕期骶骨部位PPT降低与产后疼痛性质评分较高相关（r = -0.384，p = 0.040）。结论 在该队列中，研究结果表明孕期ASLR表现不佳和骨盆局部压力疼痛超敏分别与产后身体HRQoL和疼痛性质相关。意义 疼痛敏感性可能影响孕期LPP女性的预后。这些探索性结果对于设计更大规模的预后研究可能很重要，并且可能有助于指导产后LPP的潜在疼痛管理。
