Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland.
Faculty of Business Management and Social Sciences, Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany.
Musculoskelet Sci Pract. 2020 Dec;50:102261. doi: 10.1016/j.msksp.2020.102261. Epub 2020 Sep 17.
Despite normal neurological integrity tests, some patients with non-specific neck-arm pain (NSNAP) have heightened nerve mechanosensitivity upon neurodynamic testing. The aim of this study was to determine whether or not a nerve dysfunction is present in patients with positive neurodynamic tests compared to those with negative neurodynamic tests or healthy controls. Somatosensory profiling using quantitative sensory testing (QST) was established in 40 consecutive patients with unilateral NSNAP; 23 had positive upper limb neurodynamic tests (ULNT) and 17 had negative neurodynamic tests (ULNT) and in 26 healthy controls. QST included measurement of thermal and mechanical detection and pain thresholds in the maximal pain area on the symptomatic side as well as the corresponding contralateral area. Fifty-seven percent of patients with NSNAP had positive neurodynamic tests. Somatosensory profiling revealed a loss of function phenotype in NSNAP patients compared to healthy controls both in the maximal pain area and asymptomatic side. Hyperalgesia (cold, heat and pressure) was present bilaterally in both NSNAP groups. Direct comparison between the patient groups revealed no significant differences in somatosensory profiles. However, the ULNT group demonstrated sensory loss compared to healthy controls in more parameters than the ULNT group. The ULNT subgroup represented an intermediate phenotype between ULNT patients and healthy controls in most detection thresholds as well as thermal and pressure pain thresholds. Even though patients with NSNAP present as a spectrum, it remains unclear whether the sensory changes are indicative of a nerve dysfunction/lesion or rather a marker of altered central pain processing.
尽管神经学检查正常，但一些非特异性颈臂痛（NSNAP）患者在神经动力学测试时神经机械感觉敏感性增高。本研究旨在确定阳性神经动力学测试的患者与阴性神经动力学测试或健康对照组的患者之间是否存在神经功能障碍。对 40 例单侧 NSNAP 连续患者进行了定量感觉测试（QST）的躯体感觉分析；23 例患者上肢神经动力学测试（ULNT）阳性，17 例患者 ULNT 阴性，26 例健康对照。QST 包括测量在症状侧和相应的对侧最大疼痛区域的热和机械感觉阈值以及疼痛阈值。57%的 NSNAP 患者神经动力学测试阳性。与健康对照组相比，NSNAP 患者的躯体感觉分析显示在最大疼痛区域和无症状侧均存在功能丧失表型。两种 NSNAP 组均存在双侧痛觉过敏（冷、热和压）。患者组之间的直接比较未显示躯体感觉分析存在显著差异。然而，ULNT 组与健康对照组相比，在更多的参数中表现出感觉丧失，而 ULNT 组的感觉丧失程度比 ULNT 组更明显。ULNT 亚组在大多数检测阈值以及热和压痛阈值方面表现出 ULNT 患者和健康对照组之间的中间表型。尽管 NSNAP 患者表现为一种谱，但感觉变化是否表明存在神经功能障碍/损伤，还是更可能是改变的中枢疼痛处理的标志物仍不清楚。
