B. Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel.
Eur J Pain. 2022 Jul;26(6):1269-1281. doi: 10.1002/ejp.1947. Epub 2022 Apr 12.
BACKGROUND: Painful lumbar radiculopathy is a neuropathic pain condition, commonly attributed to nerve root inflammation/compression by disc herniation. The present exploratory study searched for associations between pain intensity and inflammatory markers, herniated disc size, infection, psychological factors and pain modulation in patients with confirmed painful lumbar radiculopathy scheduled for spine surgery. METHODS: Prior to surgery, 53 patients underwent the following evaluation: pain intensity measured on a 0-10 numeric rating scale (NRS) and the Short-Form McGill Pain Questionnaire; sensory testing (modified DFNS protocol); pain processing including temporal summation and conditioned pain modulation (CPM); neurological examination; psychological assessment including Spielberger's Anxiety Inventory, Pain Sensitivity Questionnaire and the Pain Catastrophizing Scale. Pro-inflammatory cytokine levels (IL-1b, IL-6, IL-8, IL-17, TNFα, IFNg) and microbial infection (ELISA and rt-PCR) in blood and disc samples obtained during surgery. MRI scans assessments for disc herniation size/volume (MSU classification/ three-dimensional volumetric analysis). RESULTS: Complete data were available from 40 (75%) patients (15 female) aged 44.8 ± 16.3 years. Pain intensity (NRS) positively correlated with pain catastrophizing and CPM (r = 0.437, p = 0.006; r = 0.421, p = 0.007; respectively), but not with disc/blood cytokine levels, bacterial infection or MRI measures. CPM (p = 0.001) and gender (p = 0.029) were associated with average pain intensity (adjusted R = 0.443). CONCLUSIONS: This exploratory study suggests that pain catastrophizing, CPM and gender, seem to contribute to pain intensity in patients with painful lumbar radiculopathy. The role of mechanical compression and inflammation in determining the intensity of painful radiculopathy remains obscure. SIGNIFICANCE OF STUDY: Pain catastrophizing, CPM and gender rather than objective measures of inflammation and imaging seem to contribute to pain in patients with painful radiculopathy.
背景：腰痛性坐骨神经痛是一种神经病理性疼痛，通常归因于椎间盘突出导致神经根炎症/压迫。本探索性研究旨在探讨疼痛强度与炎症标志物、椎间盘突出大小、感染、心理因素和疼痛调节之间的关系，这些患者患有确诊的腰痛性坐骨神经痛，需要接受脊柱手术。
方法：在手术前，53 名患者接受了以下评估：使用 0-10 数字评分量表（NRS）和简化 McGill 疼痛问卷评估疼痛强度；感觉测试（改良 DFNS 方案）；疼痛处理包括时间总和和条件性疼痛调制（CPM）；神经学检查；心理评估包括斯皮尔伯格焦虑量表、疼痛敏感性问卷和疼痛灾难化量表。手术期间获得血液和椎间盘样本的促炎细胞因子水平（IL-1b、IL-6、IL-8、IL-17、TNFα、IFNg）和微生物感染（ELISA 和 rt-PCR）。MRI 扫描评估椎间盘突出大小/体积（MSU 分类/三维体积分析）。
结果：40 名（75%）患者（15 名女性）年龄为 44.8 ± 16.3 岁，完成了全部数据采集。疼痛强度（NRS）与疼痛灾难化和 CPM 呈正相关（r=0.437，p=0.006；r=0.421，p=0.007；分别），但与椎间盘/血液细胞因子水平、细菌感染或 MRI 测量无关。CPM（p=0.001）和性别（p=0.029）与平均疼痛强度相关（调整后的 R2=0.443）。
结论：本探索性研究表明，疼痛灾难化、CPM 和性别似乎是腰痛性坐骨神经痛患者疼痛强度的决定因素。机械压迫和炎症在确定疼痛性根性神经病疼痛强度中的作用尚不清楚。
研究意义：疼痛灾难化、CPM 和性别而不是炎症和影像学的客观测量似乎与疼痛性根性神经病患者的疼痛有关。
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