Shulman Julie, Zurakowski David, Keysor Julie, Jervis Kelsey, Sethna Navil F
Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, MA, United States.
Interprofessional PhD in Rehabilitation Science Program, MGH Institute of Health Professions, Boston, MA, United States.
Pain. 2020 Dec;161(12):2852-2859. doi: 10.1097/j.pain.0000000000001984.
Offset analgesia (OA), a psychophysical test of endogenous pain inhibition, is diminished in many adult chronic pain disorders but OA has not been investigated in youth with chronic pain disorders. This study assessed OA responses in 30 youth with chronic primary and secondary pain disorders and 32 healthy controls. The OA, control, and constant thermal tests were evoked with an individualized noxious heat stimulus of approximately 50/100 mm on a visual analogue scale followed by 1°C offset temperature. This study also examined the association of OA responses with 2 self-report measures of pain sensitivity, the Central Sensitization Inventory (CSI) and Pain Sensitivity Questionnaire. Patients exhibited diminished capacity to activate OA with a reduction in ΔeVASc of 53 ± 29% vs controls 74 ± 24% (P = 0.003) even after multivariate regression adjusting for age, sex, and body mass index. Patients also showed decreased ability to habituate to a constant noxious heat stimulus compared to controls (P = 0.021). Central Sensitization Inventory scores showed excellent predictive accuracy in differentiating patients from controls (area under the curve = 0.95; 95% CI: 0.91-0.99) and CSI score ≥30 was identified as an optimal cutoff value. Pain Sensitivity Questionnaire scores did not differentiate patients from controls nor correlate with OA. In this study, 60% of youth with chronic pain showed reduced capacity for endogenous pain inhibition.
抵消性镇痛（OA）是一种对内源性疼痛抑制的心理物理学测试，在许多成人慢性疼痛疾病中会减弱，但尚未在患有慢性疼痛疾病的青少年中进行研究。本研究评估了30名患有慢性原发性和继发性疼痛疾病的青少年以及32名健康对照者的OA反应。OA、对照和恒定热测试通过在视觉模拟量表上约50/100毫米的个体化有害热刺激诱发，随后是1°C的抵消温度。本研究还检查了OA反应与两种疼痛敏感性自我报告测量方法（中枢敏化量表（CSI）和疼痛敏感性问卷）之间的关联。即使在对年龄、性别和体重指数进行多变量回归调整后，患者激活OA的能力仍有所下降，ΔeVASc降低了53±29%，而对照组为74±24%（P = 0.003）。与对照组相比，患者对恒定有害热刺激的适应能力也有所下降（P = 0.021）。中枢敏化量表得分在区分患者和对照组方面显示出极佳的预测准确性（曲线下面积 = 0.95；95%置信区间：0.91 - 0.99），且CSI得分≥30被确定为最佳临界值。疼痛敏感性问卷得分既不能区分患者和对照组，也与OA无相关性。在本研究中，60%患有慢性疼痛的青少年表现出内源性疼痛抑制能力下降。
