Coppieters Michel W, Rehn Börje, Plinsinga Melanie L
Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia; Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Community Medicine and Rehabilitation, Faculty of Medicine, Umeå University, Umeå, Sweden.
Musculoskelet Sci Pract. 2021 Aug;54:102387. doi: 10.1016/j.msksp.2021.102387. Epub 2021 May 6.
With medical information widely available, patients often have preconceived ideas regarding diagnostic procedures and management strategies.
To investigate whether expectations, such as beliefs about the source of symptoms and knowledge about diagnostic tests, influence pain perception during a clinical diagnostic test.
Cross-sectional study.
Pain was induced by intramuscular hypertonic saline infusion in the thenar muscles. In line with sample size calculations, fifteen participants were included. All participants received identical background information regarding basic median nerve biomechanics and basic concepts of differential diagnosis via mechanical loading of painful structures. Based on different explanations about the origin of their induced pain, half of the participants believed (correctly) they had 'muscle pain' and half believed (incorrectly) they had 'nerve pain'. Pain intensity and size of the painful area were evaluated in five different positions of the median nerve neurodynamic test (ULNT1 ). Data were analysed with two-way analyses of variance.
/findings: Changes in pain in the ULNT1 positions were different between the 'muscle pain' and 'nerve pain' group (p < 0.001). In line with their expectations, the 'muscle pain' group demonstrated no changes in pain throughout the test (p > 0.38). In contrast, pain intensity (p ≤ 0.003) and size of the painful area (p ≤ 0.03) increased and decreased in the 'nerve pain' group consistent with their expectations and the level of mechanical nerve loading.
Pain perception during a clinical diagnostic test may be substantially influenced by pain anticipation. Moreover, pain was more aligned with beliefs and expectations than with the actual pathobiological process.
随着医学信息广泛可得，患者对于诊断程序和管理策略往往有先入为主的观念。
调查诸如对症状来源的看法和对诊断测试的了解等期望是否会在临床诊断测试期间影响疼痛感知。
横断面研究。
通过在鱼际肌内注射高渗盐水诱发疼痛。根据样本量计算，纳入了15名参与者。所有参与者都通过对疼痛结构进行机械负荷获得了关于正中神经基本生物力学和鉴别诊断基本概念的相同背景信息。基于对诱发疼痛来源的不同解释，一半参与者（正确地）认为自己有“肌肉疼痛”，另一半参与者（错误地）认为自己有“神经疼痛”。在正中神经动态试验（ULNT1）的五个不同位置评估疼痛强度和疼痛区域大小。数据采用双向方差分析进行分析。
/发现：“肌肉疼痛”组和“神经疼痛”组在ULNT1位置的疼痛变化不同（p< .001）。与他们的预期一致，“肌肉疼痛”组在整个测试过程中疼痛没有变化（p> .38）。相比之下，“神经疼痛”组的疼痛强度（p≤ .003）和疼痛区域大小（p≤ .03）根据他们的预期和神经机械负荷水平增加和减少。
临床诊断测试期间的疼痛感知可能会受到疼痛预期的显著影响。此外，疼痛与信念和预期的一致性高于与实际病理生物学过程的一致性。
