Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.
Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia.
J Pain. 2024 Sep;25(9):104584. doi: 10.1016/j.jpain.2024.104584. Epub 2024 May 31.
Pain hypersensitivity is present in some people with acute low back pain (LBP) and thought to be involved in the development of chronic LBP. Early evidence suggests that pain hypersensitivity in acute LBP precedes poor long-term outcome. We aimed to examine whether the presence of pain hypersensitivity in acute LBP influenced recovery status at 6 months and differentiated how pain and disability changed over time. Participants with acute nonspecific LBP (<6 weeks after pain onset, N = 118) were included in this longitudinal study. Quantitative sensory testing, including pressure and heat pain thresholds, and conditioned pain modulation and questionnaires were compared at baseline and longitudinally (at 3 and 6 months) between recovered and unrecovered participants. Using k-means clustering, we identified subgroups based on baseline sensory measures alone, and in combination with psychological factors, and compared pain and disability outcomes between subgroups. Sensory measures did not differ at baseline or longitudinally between recovered (N = 50) and unrecovered (N = 68) participants. Subgrouping based on baseline sensory measures alone did not differentiate pain or disability outcomes at any timepoint. Participants with high psychological distress at baseline (N = 19) had greater disability, but not pain, at all timepoints than those with low psychological distress, regardless of the degrees of pain sensitivity. Our findings suggest that pain hypersensitivity in acute LBP does not precede poor recovery at 6 months or differentiate how pain and disability change over time. High psychological distress during acute LBP is associated with unremitting and pronounced disability, while pain severity is unaffected. PERSPECTIVE: Pain hypersensitivity is thought to be involved in the transition to chronic LBP. Contradictory to prevailing hypothesis, our findings suggest pain hypersensitivity alone in acute LBP does not precede poor recovery. High psychological distress in acute LBP has a stronger influence than pain hypersensitivity on long-term disability, but not pain outcomes.
疼痛敏化存在于一些急性腰痛（LBP）患者中，被认为与慢性 LBP 的发展有关。早期证据表明，急性 LBP 中的疼痛敏化先于长期预后不良。我们旨在研究急性 LBP 中疼痛敏化的存在是否会影响 6 个月时的恢复状况，并区分疼痛和残疾随时间的变化。本纵向研究纳入了急性非特异性 LBP（疼痛发作后<6 周，N=118）患者。在基线和随访时（3 个月和 6 个月），对恢复和未恢复的参与者比较了定量感觉测试（包括压力和热痛阈值以及条件性疼痛调制和问卷）。使用 K-均值聚类，我们根据基线感觉测量值单独以及与心理因素相结合，识别了亚组，并比较了亚组之间的疼痛和残疾结果。在基线或随访时，恢复组（N=50）和未恢复组（N=68）之间的感觉测量值没有差异。仅基于基线感觉测量值的亚组分组并不能在任何时间点区分疼痛或残疾结果。基线时心理困扰较高的参与者（N=19）在所有时间点的残疾程度均高于心理困扰较低的参与者，但疼痛程度不受影响。我们的研究结果表明，急性 LBP 中的疼痛敏化并不能预示 6 个月时恢复不良，也不能区分疼痛和残疾随时间的变化。急性 LBP 期间的高心理困扰与持续存在和明显的残疾有关，而疼痛严重程度不受影响。观点：疼痛敏化被认为与慢性 LBP 的转变有关。与流行的假说相反，我们的研究结果表明，急性 LBP 中的疼痛敏化单独存在并不能预示恢复不良。急性 LBP 中的高心理困扰对长期残疾的影响比疼痛敏化更强，而对疼痛结果的影响较小。
