Georgopoulos Vasileios, Akin-Akinyosoye Kehinde, Smith Stephanie, McWilliams Daniel F, Hendrick Paul, Walsh David A
Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom.
Pain Rep. 2022 Apr 13;7(3):e1003. doi: 10.1097/PR9.0000000000001003. eCollection 2022 May-Jun.
Central pain facilitation can hinder recovery in people with chronic low back pain (CLBP).
The objective of this observational study was to investigate whether indices of centrally facilitated pain are associated with pain outcomes in a hospital-based cohort of individuals with CLBP undertaking a pain management programme.
Participants provided self-report and pain sensitivity data at baseline (n = 97) and again 3 months (n = 87) after a cognitive behavioural therapy-based group intervention including physiotherapy. Indices of centrally facilitated pain were pressure pain detection threshold, temporal summation and conditioned pain modulation at the forearm, Widespread Pain Index (WPI) classified using a body manikin, and a Central Mechanisms Trait (CMT) factor derived from 8 self-reported characteristics of anxiety, depression, neuropathic pain, fatigue, cognitive dysfunction, pain distribution, catastrophizing, and sleep. Pain severity was a composite factor derived from Numerical Rating Scales. Cross-sectional and longitudinal regression models were adjusted for age and sex.
Baseline CMT and WPI each was associated with higher pain severity (CMT: = 0.50, < 0.001; WPI: = 0.21, = 0.04) at baseline and at 3 months (CMT: = 0.38, < 0.001; WPI: = 0.24, = 0.02). High baseline CMT remained significantly associated with pain at 3 months after additional adjustment for baseline pain (β = 2.45, = 0.04, = 0.25, < 0.0001). Quantitative sensory testing indices of pain hypersensitivity were not significantly associated with pain outcomes at baseline or at 3 months.
Central mechanisms beyond those captured by quantitative sensory testing are associated with poor CLBP outcome and might be targets for improved therapy.
中枢性疼痛易化会阻碍慢性下腰痛（CLBP）患者的康复。
本观察性研究的目的是调查在一个接受疼痛管理计划的CLBP住院患者队列中，中枢性易化疼痛指标是否与疼痛结局相关。
参与者在基线时（n = 97）以及在基于认知行为疗法并包括物理治疗的小组干预3个月后（n = 87）再次提供自我报告和疼痛敏感性数据。中枢性易化疼痛指标包括前臂的压力疼痛检测阈值、时间总和及条件性疼痛调制、使用人体模型分类的广泛疼痛指数（WPI），以及从焦虑、抑郁、神经性疼痛、疲劳、认知功能障碍、疼痛分布、灾难化和睡眠这8个自我报告特征中得出的中枢机制特质（CMT）因子。疼痛严重程度是从数字评分量表得出的综合因子。横断面和纵向回归模型针对年龄和性别进行了调整。
基线时CMT和WPI均与较高的疼痛严重程度相关（CMT：β = 0.50，P < 0.001；WPI：β = 0.21，P = 0.04），在3个月时也是如此（CMT：β = 0.38，P < 0.001；WPI：β = 0.24，P = 0.02）。在对基线疼痛进行额外调整后，高基线CMT在3个月时仍与疼痛显著相关（β = 2.45，P = 0.04，R² = 0.25，P < 0.0001）。疼痛超敏反应的定量感觉测试指标在基线或3个月时与疼痛结局均无显著关联。
定量感觉测试所捕获之外的中枢机制与CLBP不良结局相关，可能是改善治疗的靶点。
