第一跖趾关节骨关节炎相关的神经性疼痛：频率及相关因素。
Neuropathic Pain Associated With First Metatarsophalangeal Joint Osteoarthritis: Frequency and Associated Factors.
机构信息
La Trobe University, Melbourne, Victoria, Australia.
Monash University and Alfred Hospital, Melbourne, Victoria, Australia.
出版信息
Arthritis Care Res (Hoboken). 2023 Oct;75(10):2127-2133. doi: 10.1002/acr.25125. Epub 2023 May 11.
OBJECTIVE
To determine whether neuropathic pain is a feature of first metatarsophalangeal (MTP) joint osteoarthritis (OA).
METHODS
A total of 98 participants (mean ± SD age 57.4 ± 10.3 years) with symptomatic radiographic first MTP joint OA completed the PainDETECT questionnaire (PD-Q), which has 9 questions regarding the intensity and quality of pain. The likelihood of neuropathic pain was determined using established PD-Q cutoff points. Participants with unlikely neuropathic pain were then compared to those with possible/likely neuropathic pain in relation to age, sex, general health (Short Form 12 [SF-12] health survey), psychological well-being (Depression, Anxiety and Stress Scale), pain characteristics (self-efficacy, duration, and severity), foot health (Foot Health Status Questionnaire [FHSQ]), first MTP dorsiflexion range of motion, and radiographic severity. Effect sizes (Cohen's d coefficient) were also calculated.
RESULTS
A total of 30 (31%) participants had possible/likely neuropathic pain (19 possible [19.4%], 11 likely [11.2%]). The most common neuropathic symptoms were sensitivity to pressure (56%), sudden pain attacks/electric shocks (36%) and burning (24%). Compared to those with unlikely neuropathic pain, those with possible/likely neuropathic pain were significantly older (d = 0.59, P = 0.010), had worse SF-12 physical scores (d = 1.10, P < 0.001), pain self-efficacy scores (d = 0.98, P < 0.001), FHSQ pain scores (d = 0.98, P < 0.001), and FHSQ function scores (d = 0.82, P < 0.001), and had higher pain severity at rest (d = 1.01, P < 0.001).
CONCLUSION
A significant proportion of individuals with first MTP joint OA report symptoms suggestive of neuropathic pain, which may partly explain the suboptimal responses to commonly used treatments for this condition. Screening for neuropathic pain may be useful in the selection of targeted interventions and may improve clinical outcomes.
目的
确定神经性疼痛是否为第一跖趾（MTP）关节骨关节炎（OA）的特征。
方法
共有 98 名有症状的放射学第一 MTP 关节 OA 患者（平均年龄 57.4 ± 10.3 岁）完成了疼痛 DETECT 问卷（PD-Q），该问卷包含 9 个关于疼痛强度和质量的问题。使用既定的 PD-Q 截断点确定神经性疼痛的可能性。将可能性/可能性较小的神经性疼痛的参与者与可能/可能性较大的神经性疼痛的参与者进行比较，比较内容为年龄、性别、一般健康状况（简短形式 12 [SF-12]健康调查）、心理幸福感（抑郁、焦虑和压力量表）、疼痛特征（自我效能、持续时间和严重程度）、足部健康状况（足部健康状况问卷 [FHSQ]）、第一 MTP 背屈活动范围和放射学严重程度。还计算了效应大小（Cohen's d 系数）。
结果
共有 30 名（31%）参与者可能/可能有神经性疼痛（19 名可能[19.4%]，11 名可能[11.2%]）。最常见的神经性症状是对压力敏感（56%）、突然疼痛发作/电击（36%）和烧灼感（24%）。与可能性/可能性较小的神经性疼痛相比，可能性/可能性较大的神经性疼痛的参与者年龄明显较大（d=0.59，P=0.010），SF-12 生理评分（d=1.10，P<0.001），疼痛自我效能评分（d=0.98，P<0.001），FHSQ 疼痛评分（d=0.98，P<0.001）和 FHSQ 功能评分（d=0.82，P<0.001），并且休息时疼痛严重程度更高（d=1.01，P<0.001）。
结论
相当一部分患有第一跖趾关节 OA 的患者报告有神经性疼痛的症状，这可能部分解释了这种疾病常用治疗方法反应不佳的原因。筛查神经性疼痛可能有助于选择针对性干预措施，并可能改善临床结果。
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