School of Health and Rehabilitation Science, The University of Queensland, QLD, Australia.
Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland.
Pain. 2021 Aug 1;162(8):2225-2236. doi: 10.1097/j.pain.0000000000002213.
To better understand the mechanisms underpinning work-related neck pain, this cross-sectional and single-blinded study compared somatosensory profiles among sonographers with varied neck disability levels. Based on K-mean cluster analysis of scores on the neck disability index (NDI), participants were classified into no (NDI ≤ 8%, n = 31, reference group), mild (NDI = 10%-20%, n = 43), or moderate/severe (NDI ≥ 22%, n = 18) disability groups. Data were collected on bodily pain distribution and severity and psychological measures including depression, anxiety, pain-catastrophizing, and fear-avoidance beliefs using validated scales. Participants attended 1 session of quantitative sensory testing performed according to a standardized protocol, including local and remote thermal and mechanical pain thresholds, temporal summation of pain (TSP), conditioned pain modulation, and an exercise-induced analgesia paradigm. Compared with participants with no and mild disability, those with moderate/severe disability showed more widespread pain, cold and mechanical hyperalgesia at a remote nonpainful site, and significantly higher TSP. Participants with mild disability demonstrated significantly higher TSP than those with no disability. These group differences were attenuated after adjusting for depression or anxiety, indicating these psychological factors may mediate the somatosensory changes associated with neck disability. Group differences were not found for conditioned pain modulation or exercise-induced analgesia. These findings suggest that heightened pain facilitation, rather than impaired pain inhibition may underpin nociplastic pain in participants with moderate/severe disability, and it may be associated with depression and anxiety. Clinicians should be aware that individuals with work-related neck pain presenting with moderate/severe disability display distinct somatosensory features and tailor management strategies accordingly.
为了更好地理解与工作相关的颈部疼痛的发病机制，本横断面单盲研究比较了不同颈部残疾程度的超声科医生的躯体感觉特征。根据颈痛残疾指数（NDI）得分的 K-均值聚类分析，将参与者分为无残疾（NDI≤8%，n=31，参考组）、轻度残疾（NDI=10%-20%，n=43）或中重度残疾（NDI≥22%，n=18）组。使用经过验证的量表收集躯体疼痛分布和严重程度以及心理测量数据，包括抑郁、焦虑、疼痛灾难化和恐惧回避信念。参与者参加了 1 次定量感觉测试，该测试按照标准化方案进行，包括局部和远程热痛和机械痛阈值、疼痛的时间总和（TSP）、条件性疼痛调制和运动诱导的镇痛范式。与无残疾和轻度残疾的参与者相比，中重度残疾的参与者表现出更广泛的疼痛、远端无痛部位的冷和机械性痛觉过敏以及显著更高的 TSP。轻度残疾的参与者的 TSP 明显高于无残疾的参与者。这些组间差异在调整抑郁或焦虑后减弱，表明这些心理因素可能介导与颈部残疾相关的躯体感觉变化。条件性疼痛调制或运动诱导的镇痛没有发现组间差异。这些发现表明，中重度残疾参与者的疼痛易化增强，而疼痛抑制受损可能是神经病理性疼痛的基础，可能与抑郁和焦虑有关。临床医生应该意识到，有与工作相关的颈部疼痛且表现为中重度残疾的个体表现出明显的躯体感觉特征，应相应地调整管理策略。
