Brady Sophia M, Georgopoulos Vasileios, Veldhuijzen van Zanten Jet J C S, Duda Joan L, Metsios George S, Kitas George D, Fenton Sally A M, Walsh David A, McWilliams Daniel F
School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.
Rheumatology Department, Dudley Group NHS Foundation Trust, Dudley, United Kingdom.
Pain Rep. 2023 Oct 10;8(6):e1102. doi: 10.1097/PR9.0000000000001102. eCollection 2023 Dec.
Quantitative Sensory Testing (QST) modalities used to assess central pain mechanisms require different protocols in people with different musculoskeletal conditions.
We aimed to explore the possible effects of musculoskeletal diagnosis and test site on QST interrater and test-retest reliability.
The study included participants with rheumatoid arthritis (RA, n = 18; QST conducted on lower leg) and low back pain (LBP, n = 25; QST conducted on forearm), plus 45 healthy control participants (n = 20 QST on lower leg and n = 25 QST on forearm). Test-retest reliability was assessed from QST conducted 1 to 3 weeks apart. Quantitative sensory testing modalities used were pressure pain detection threshold (PPT) at a site distant to tissue pathology, temporal summation (TS), and conditioned pain modulation (CPM). Temporal summation was calculated as difference or ratio of single and repeated punctate stimuli and unconditioned thresholds for CPM used single or mean of multiple PPTs. Intraclass correlation coefficients (ICCs) were compared between different subgroups.
High to very high reliability was found for all assessments of PPT and TS across anatomical sites (lower leg and forearm) and participants (healthy, RA, and LBP) (ICC ≥ 0.77 for PPT and ICC ≥ 0.76 for TS). Reliability was higher when TS was calculated as a difference rather than a ratio. Conditioned pain modulation showed no to moderate reliability (ICC = 0.01-0.64) that was similar between leg or forearm, and between healthy people and those with RA or LBP.
PPT and TS are transferable tools to quantify pain sensitivity at different testing sites in different musculoskeletal diagnoses. Low apparent reliability of CPM protocols might indicate minute-to-minute dynamic pain modulation.
用于评估中枢性疼痛机制的定量感觉测试（QST）模式在患有不同肌肉骨骼疾病的人群中需要不同的方案。
我们旨在探讨肌肉骨骼诊断和测试部位对QST评分者间信度和重测信度的可能影响。
该研究纳入了类风湿关节炎（RA，n = 18；在小腿进行QST）和腰痛（LBP，n = 25；在 forearm进行QST）的参与者，以及45名健康对照参与者（n = 20在小腿进行QST，n = 25在forearm进行QST）。通过相隔1至3周进行的QST评估重测信度。使用的定量感觉测试模式包括远离组织病理学部位的压力疼痛检测阈值（PPT）、时间总和（TS）和条件性疼痛调制（CPM）。时间总和计算为单次和重复点状刺激的差值或比值，CPM的非条件阈值使用多个PPT的单个值或平均值。比较不同亚组之间的组内相关系数（ICC）。
在所有解剖部位（小腿和forearm）和参与者（健康、RA和LBP）中，PPT和TS的所有评估均发现高至非常高的信度（PPT的ICC≥0.77，TS的ICC≥0.76）。当将TS计算为差值而非比值时，信度更高。条件性疼痛调制显示出低至中等的信度（ICC = 0.01 - 0.64），在小腿或forearm之间以及健康人与RA或LBP患者之间相似。
PPT和TS是在不同肌肉骨骼诊断中量化不同测试部位疼痛敏感性的可转移工具。CPM方案的明显低信度可能表明疼痛调制存在每分钟的动态变化。
