Integrated Program in Neurosciences, McGill University, Montreal, Québec, Canada; McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada; Alan Edwards Centre for Research on Pain, Montreal, Québec, Canada.
McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada; Alan Edwards Centre for Research on Pain, Montreal, Québec, Canada.
Spine J. 2019 Apr;19(4):677-686. doi: 10.1016/j.spinee.2018.10.009. Epub 2018 Oct 19.
Although 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms.
To identify the presence of sensitization in nociceptive pathways and to assess the efficacy of the diffuse noxious inhibitory control in patients with AIS presenting with chronic back pain.
Cross-sectional study.
Ninety-four patients diagnosed with AIS and chronic back pain.
Quantitative sensory testing (QST) assessed pain modulation and self-reported questionnaires were used to assess pain burden and health-related quality of life.
Patients underwent a detailed pain assessment using a standard and validated quantitative sensory testing (QST) protocol. The measurements included mechanical detection thresholds (MDT), pain pressure threshold (PPT), heat pain threshold (HPT), heat tolerance threshold (HTT), and a conditioned pain modulation (CPM) paradigm. Altogether, these tests measured changes in regulation of the neurophysiology underlying the nociceptive processes based on the patient's pain perception. Funding was provided by The Louise and Alan Edwards Foundation and The Shriners Hospitals for Children.
Efficient pain inhibitory response was observed in 51.1% of patients, while 21.3% and 27.7% had sub-optimal and inefficient CPM, respectively. Temporal summation of pain was observed in 11.7% of patients. Significant correlations were observed between deformity severity and pain pressure thresholds (p=.023) and CPM (p=.017), neuropathic pain scores and pain pressure thresholds (p=.015) and temporal summation of pain (p=.047), and heat temperature threshold and pain intensity (p=.048).
Chronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome.
虽然 40%的青少年特发性脊柱侧凸（AIS）患者存在慢性背痛，但病理生理学和潜在的疼痛机制仍知之甚少。我们假设 AIS 慢性疼痛综合征的发展与疼痛调节机制的改变有关。
确定伤害性通路中是否存在致敏现象，并评估弥漫性伤害性抑制控制（DNIC）在患有慢性背痛的 AIS 患者中的疗效。
横断面研究。
94 名被诊断为 AIS 并伴有慢性背痛的患者。
定量感觉测试（QST）评估疼痛调节，自我报告问卷用于评估疼痛负担和健康相关生活质量。
患者接受了详细的疼痛评估，使用标准和经过验证的定量感觉测试（QST）方案。测量包括机械检测阈值（MDT）、疼痛压力阈值（PPT）、热痛阈值（HPT）、热耐受阈值（HTT）和条件性疼痛调制（CPM）范式。这些测试共同测量了根据患者的疼痛感知，对伤害性过程神经生理学调节的变化。研究资金由 Louise 和 Alan Edwards 基金会以及 Shriners 儿童医院提供。
在 51.1%的患者中观察到有效的疼痛抑制反应，而 21.3%和 27.7%的患者分别具有亚最佳和无效的 CPM。11.7%的患者出现疼痛时间总和。畸形严重程度与疼痛压力阈值（p=.023）和 CPM（p=.017）、神经病理性疼痛评分与疼痛压力阈值（p=.015）和疼痛时间总和（p=.047）以及热温度阈值与疼痛强度（p=.048）呈显著相关。
慢性背痛会影响特发性脊柱侧凸青少年的生活质量。我们证明了这群人存在疼痛调节受损的高患病率。畸形严重程度与躯体感觉功能障碍之间的关联表明，脊柱畸形可能是导致该人群异常神经可塑性变化的触发因素，从而导致慢性疼痛综合征。
