Department of Physical Therapy, School of Science and Technology, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil; Department of Physical Therapy, UniAmérica Descomplica Centro Universitário, Foz do Iguaçu, Brazil. Electronic address: https://twitter.com/amandaschenatto.
Centre for Sports and Exercise Medicine, School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. Electronic address: https://twitter.com/simonthephysio.
Braz J Phys Ther. 2022 Jul-Aug;26(4):100430. doi: 10.1016/j.bjpt.2022.100430. Epub 2022 Jul 13.
Young adults with patellofemoral pain (PFP) have a high prevalence of being overweight or obese, which is associated with impaired lower limb function and muscle weakness. However, the impact of being overweight or obese on pain sensitivity has not been explored.
We investigated the association between body fat, skeletal muscle mass, and body mass index (BMI) with pressure hyperalgesia and self-reported pain in young adults with PFP.
114 adults with PFP (24 ± 5 years old, 62% women) were recruited. Demographics and self-reported pain (current and worst knee pain intensity in the previous month - 0-100 mm visual analog scale) were recorded. Body fat and skeletal muscle mass were measured using bioelectrical impedance. Pressure hyperalgesia was measured using a handheld algometer (pressure pain threshold) at three sites: center of patella of the painful knee, ipsilateral tibialis anterior, and contralateral upper limb. The association between body fat, skeletal muscle mass, and BMI with pressure hyperalgesia and self-reported pain were investigated using partial correlations and hierarchical regression models (adjusted for sex, bilateral pain, and symptoms duration).
Higher body fat and lower skeletal muscle mass were associated with local, spread, and widespread pressure hyperalgesia (ΔR=0.09 to 0.17, p ≤ 0.001; ΔR=0.14 to 0.26, p<0.001, respectively), and higher current self-reported pain (ΔR=0.10, p<0.001; ΔR=0.06, p = 0.007, respectively). Higher BMI was associated with higher current self-reported pain (ΔR=0.10, p = 0.001), but not with any measures of pressure hyperalgesia (p>0.05).
Higher body fat and lower skeletal muscle mass help to explain local, spread, and widespread pressure hyperalgesia, and self-reported pain in people with PFP. BMI only helps to explain self-reported pain. These factors should be considered when assessing people with PFP and developing their management plan, but caution should be taken as the strength of association was generally low.
患有髌股疼痛（PFP）的年轻人中，超重或肥胖的比例较高，这与下肢功能受损和肌肉无力有关。然而，超重或肥胖对疼痛敏感性的影响尚未得到探索。
我们研究了体脂肪、骨骼肌质量和体重指数（BMI）与髌股疼痛年轻人的压痛敏化和自报告疼痛之间的关系。
招募了 114 名患有 PFP 的成年人（24±5 岁，62%为女性）。记录了人口统计学数据和自报告疼痛（当前和上个月最严重的膝关节疼痛强度-0-100mm 视觉模拟量表）。使用生物电阻抗法测量体脂肪和骨骼肌质量。使用手持压痛计（压痛阈值）在三个部位测量压痛敏化：疼痛膝关节的髌骨中心、同侧胫骨前肌和对侧上肢。使用偏相关和分层回归模型（调整性别、双侧疼痛和症状持续时间）研究体脂肪、骨骼肌质量和 BMI 与压痛敏化和自报告疼痛之间的关系。
较高的体脂肪和较低的骨骼肌质量与局部、扩散和广泛的压痛敏化相关（ΔR=0.09 至 0.17，p≤0.001；ΔR=0.14 至 0.26，p<0.001），并且与更高的当前自报告疼痛相关（ΔR=0.10，p<0.001；ΔR=0.06，p=0.007）。较高的 BMI 与更高的当前自报告疼痛相关（ΔR=0.10，p=0.001），但与任何压痛敏化测量无关（p>0.05）。
较高的体脂肪和较低的骨骼肌质量有助于解释髌股疼痛患者的局部、扩散和广泛的压痛敏化和自报告疼痛。BMI 仅有助于解释自报告疼痛。在评估髌股疼痛患者并制定其管理计划时应考虑这些因素，但应谨慎，因为关联的强度通常较低。
