冻结肩的临床病程和纵向相关性探讨：自主功能、中枢疼痛处理和心理变量的作用。一项纵向多中心前瞻性观察研究。

Exploration of the clinical course and longitudinal correlations in frozen shoulder: The role of autonomic function, central pain processing, and psychological variables. A longitudinal multicenter prospective observational study.

机构信息

Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.

Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopedic Surgery, University Hospital (UZA), Edegem, Belgium.

出版信息

Musculoskelet Sci Pract. 2023 Oct;67:102857. doi: 10.1016/j.msksp.2023.102857. Epub 2023 Sep 14.

DOI:10.1016/j.msksp.2023.102857

PMID:37725869

Abstract

BACKGROUND

Altered central pain processing (CPP) and dysautonomia might play a role in the clinical course of frozen shoulder and psychological factors, like pain catastrophizing and hypervigilance, might influence clinical variables in frozen shoulder.

OBJECTIVES

To explore the clinical course of frozen shoulder regarding CPP, dysautonomia, pain catastrophizing, and hypervigilance and to explore whether longitudinal correlations between these outcomes and pain intensity were present.

DESIGN

prospective longitudinal observational study.

METHOD

Participants with frozen shoulder were recruited at hospitals and general practitioner practices and followed for 9 months. They completed six questionnaires (about demographics, shoulder pain and disability, pain intensity, pain catastrophizing, pain hypervigilance, and autonomic symptoms) and underwent tactile sensitivity (allodynia), pressure pain thresholds (hyperalgesia), temporal summation, and conditioned pain modulation during four timeframes (3-month intervals).

RESULTS

Initially, 149 participants with frozen shoulder were recruited and 88 completed all the measurements. An improvement from baseline to at least one follow-up measurement was found for shoulder pain and disability, pain intensity, pain catastrophizing, hypervigilance, and dysautonomia. A fair longitudinal correlation was found between pain intensity and catastrophizing and hypervigilance (r = 0.301-0.397). Poor longitudinal correlations were found between pain intensity and allodynia and hyperalgesia (r = -0.180-0.193), between pain catastrophizing and dysautonomia (r = 0.209) and between hypervigilance and hyperalgesia (r = -0.159).

CONCLUSION

Patients with frozen shoulder showed an early improvement that flattened with time in several pain and psychological variables over the course of 9 months. However, autonomic symptoms rather showed a late improvement over 9 months.

摘要

背景

中枢性疼痛处理改变（CPP）和自主神经功能障碍可能在冻结肩的临床病程中发挥作用，而疼痛灾难化和过度警觉等心理因素可能会影响冻结肩的临床变量。

目的

探讨冻结肩患者 CPP、自主神经功能障碍、疼痛灾难化和过度警觉的临床病程，并探讨这些结局与疼痛强度之间是否存在纵向相关性。

设计

前瞻性纵向观察研究。

方法

在医院和全科医生诊所招募冻结肩患者，并随访 9 个月。他们完成了 6 份问卷（关于人口统计学、肩部疼痛和残疾、疼痛强度、疼痛灾难化、疼痛过度警觉和自主症状），并在四个时间点（3 个月间隔）进行了触觉敏感性（感觉过敏）、压力疼痛阈值（痛觉过敏）、时间总和和条件性疼痛调制。

结果

最初招募了 149 名冻结肩患者，其中 88 名完成了所有测量。从基线到至少一次随访测量，肩部疼痛和残疾、疼痛强度、疼痛灾难化、过度警觉和自主神经功能障碍均有改善。疼痛强度与灾难化和过度警觉之间存在良好的纵向相关性（r=0.301-0.397）。疼痛强度与感觉过敏和痛觉过敏之间存在较差的纵向相关性（r=-0.180-0.193），疼痛灾难化与自主神经功能障碍之间存在较差的纵向相关性（r=0.209），过度警觉与痛觉过敏之间存在较差的纵向相关性（r=-0.159）。