长期的、有益于健康的身体活动与减轻疼痛有关，但与降低疼痛敏感性或改善类风湿关节炎患者的运动诱发的痛觉减退无关。
Long-term, health-enhancing physical activity is associated with reduction of pain but not pain sensitivity or improved exercise-induced hypoalgesia in persons with rheumatoid arthritis.
机构信息
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden.
Department of Rehabilitation Medicine, Danderyd Hospital, Building 60, SE-182 88, Stockholm, Sweden.
出版信息
Arthritis Res Ther. 2018 Nov 26;20(1):262. doi: 10.1186/s13075-018-1758-x.
BACKGROUND
We aimed to evaluate the 1-year and 2-year outcome of a health-enhancing physical activity (HEPA) support program on global pain, pressure pain sensitivity, and exercise-induced segmental and plurisegmental hypoalgesia (EIH) in persons with rheumatoid arthritis (RA).
METHODS
Thirty participants (27 women and 3 men) were recruited from a larger intervention cohort that engaged in strength training and moderate-intensity aerobic activity. Assessments were performed before the HEPA intervention and at 1-year and 2-year follow-ups. Global pain was assessed on a visual analogue scale (0-100). Pressure pain thresholds (PPTs) and suprathreshold pressure pain at rest corresponding to 4/10 (medium pain) (SP4) and 7/10 (strong pain) (SP7) on Borg CR 10 scale were assessed by algometry. In a subsample (n = 21), segmental and plurisegmental EIH were assessed during standardized submaximal static contraction (30% of the individual maximum), by algometry, alternately at the contracting right M. quadriceps and the resting left M. deltoideus.
RESULTS
Global pain decreased from before the intervention to 2-year follow-up (median 11 to median 6, P = 0.040). PPTs and SP4 pressure pain at rest did not change from before the intervention to 2-year follow-up, while SP7 decreased from mean 647 kPa to mean 560 kPa (P = 0.006). Segmental EIH during static muscle contraction increased from the assessment before the intervention (from mean 1.02 to mean 1.42, P = 0.001), as did plurisegmental EIH (from mean 0.87 to mean 1.41, P <0.001). There were no statistically significant changes in segmental or plurisegmental EIH from before the intervention to 2-year follow-up.
CONCLUSION
Participation in a long-term HEPA support program was associated with reduced global pain, whereas pressure pain sensitivity at rest was not reduced and EIH did not change. Thus, our results do not favor the hypothesis that long-term HEPA reduces pain by improving descending pain inhibition in persons with RA.
TRIAL REGISTRATION
ISRCTN25539102 , ISRCTN registry, date assigned March 4, 2011. The trial was retrospectively registered.
背景
我们旨在评估健康促进体力活动（HEPA）支持计划对类风湿关节炎（RA）患者的全球疼痛、压力疼痛敏感性以及运动诱发的节段和多节段低痛觉（EIH）的 1 年和 2 年结果。
方法
从参与力量训练和中等强度有氧运动的更大干预队列中招募了 30 名参与者（27 名女性和 3 名男性）。在 HEPA 干预之前以及 1 年和 2 年的随访中进行评估。全球疼痛通过视觉模拟量表（0-100）进行评估。通过压力测定法评估静息时的压力疼痛阈值（PPT）和相当于 Borg CR 10 量表上的 4/10（中度疼痛）（SP4）和 7/10（强烈疼痛）（SP7）的超阈值压力疼痛。在亚样本（n=21）中，通过压力测定法在标准化的亚最大静态收缩（个体最大收缩的 30%）期间评估节段和多节段 EIH，交替测量收缩右股四头肌和休息左三角肌。
结果
全球疼痛从干预前到 2 年随访时降低（中位数 11 降至中位数 6，P=0.040）。从干预前到 2 年随访时，PPT 和静息时的 SP4 压力疼痛没有变化，而 SP7 从平均 647kPa 降至平均 560kPa（P=0.006）。在静态肌肉收缩期间，节段性 EIH 从干预前的评估开始增加（从平均 1.02 增加到平均 1.42，P=0.001），多节段 EIH 也是如此（从平均 0.87 增加到平均 1.41，P<0.001）。从干预前到 2 年随访时，节段或多节段 EIH 没有统计学上的显著变化。
结论
参加长期的 HEPA 支持计划与全球疼痛减轻有关，而静息时的压力疼痛敏感性没有降低，EIH 也没有改变。因此，我们的结果不支持长期 HEPA 通过改善 RA 患者的下行疼痛抑制来减轻疼痛的假设。
试验注册
ISRCTN86425176，ISRCTN 注册，日期为 2011 年 3 月 4 日。该试验是回顾性注册的。
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