慢性腰痛放射至下肢患者的人为中枢敏化（HACS）（CLaSSICO 研究）。

Human assumed central sensitisation (HACS) in patients with chronic low back pain radiating to the leg (CLaSSICO study).

机构信息

Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands

Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands.

出版信息

BMJ Open. 2022 Jan 13;12(1):e052703. doi: 10.1136/bmjopen-2021-052703.

DOI:10.1136/bmjopen-2021-052703

PMID:35027419

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8762136/

Abstract

INTRODUCTION

Patients with chronic low back pain radiating to the leg (CLBPr) are sometimes referred to a specialised pain clinic for a precise diagnosis based, for example, on a diagnostic selective nerve root block. Possible interventions are therapeutic selective nerve root block or pulsed radiofrequency. Central pain sensitisation is not directly assessable in humans and therefore the term 'human assumed central sensitisation' (HACS) is proposed. The possible existence and degree of sensitisation associated with pain mechanisms assumed present in the human central nervous system, its role in the chronification of pain and its interaction with diagnostic and therapeutic interventions are largely unknown in patients with CLBPr. The aim of quantitative sensory testing (QST) is to estimate quantitatively the presence of HACS and accumulating evidence suggest that a subset of patients with CLBPr have facilitated responses to a range of QST tests.The aims of this study are to identify HACS in patients with CLBPr, to determine associations with the effect of selective nerve root blocks and compare outcomes of HACS in patients to healthy volunteers.

METHODS AND ANALYSIS

A prospective observational study including 50 patients with CLBPr. Measurements are performed before diagnostic and therapeutic nerve root block interventions and at 4 weeks follow-up. Data from patients will be compared with those of 50 sex-matched and age-matched healthy volunteers. The primary study parameters are the outcomes of QST and the Central Sensitisation Inventory. Statistical analyses to be performed will be analysis of variance.

ETHICS AND DISSEMINATION

The Medical Research Ethics Committee of the University Medical Center Groningen, Groningen, the Netherlands, approved this study (dossier NL60439.042.17). The results will be disseminated via publications in peer-reviewed journals and at conferences.

TRIAL REGISTRATION NUMBER

NTR NL6765.

摘要

简介

患有下肢放射痛的慢性下腰痛（CLBPr）患者有时会被转诊到专门的疼痛诊所进行精确诊断，例如基于诊断性选择性神经根阻滞。可能的干预措施包括治疗性选择性神经根阻滞或脉冲射频。人类无法直接评估中枢性疼痛敏化，因此提出了“人为假设的中枢敏化”（HACS）这一术语。与假定存在于人类中枢神经系统中的疼痛机制相关的敏化的存在及其程度、其在疼痛慢性化中的作用以及与诊断和治疗干预的相互作用，在 CLBPr 患者中很大程度上是未知的。定量感觉测试（QST）的目的是定量估计 HACS 的存在，并且越来越多的证据表明，CLBPr 患者中有一部分患者对一系列 QST 测试有促进反应。本研究的目的是在 CLBPr 患者中确定 HACS，确定其与选择性神经根阻滞效果的关联，并比较 HACS 患者与健康志愿者的结果。