Baeumler Petra, Schäfer Margherita, Möhring Luise, Irnich Dominik
Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany.
Front Neurol. 2024 Aug 23;15:1335356. doi: 10.3389/fneur.2024.1335356. eCollection 2024.
Previously, we had observed that immediate pain reduction after one acupuncture treatment was associated with high temporal summation of pain (TS) at a pain free control site and younger age in a mixed population of chronic pain patients. The aim of the present study was to verify these results in chronic non-specific low back pain (LBP) and to collect pilot data on the association between TS and the response to an acupuncture series.
TS at a pain free control site (back of dominant hand) and at the pain site was quantified by the pin-prick induced wind-up ratio (WUR) in 60 LBP patients aged 50 years or younger. Response to one acupuncture treatment was assessed by change in pain intensity and pressure pain threshold (PPT) at the pain site. The primary hypothesis was that a high TS (WUR > 2.5) would be associated with a clinically relevant reduction in pain intensity of at least 30%. In study part two, 26 patients received nine additional treatments. Response to the acupuncture series was assessed by the pain intensity during the last week, the PPT and the Hannover functional ability questionnaire (FFbH-R).
An immediate reduction in pain intensity of at least 30% was frequent irrespective of TS at the control site (low vs. high TS 58% vs. 72%, = 0.266). High TS at the pain site was also not significantly associated with a clinically relevant immediate reduction in pain intensity (low vs. high TS 46% vs. 73%, = 0.064). The PPT was not changed after one acupuncture treatment. Study part two did not reveal a consistent association between TS at the control site and any of the outcome measures but also a trend toward a higher chance for a clinically relevant response along with low TS at the pain site.
Our results do not suggest an important role of TS for predicting a clinically important acupuncture effect or the response to a series of 10 acupuncture treatments in patients with chronic non-specific LBP. Overall high response rates imply that acupuncture is a suitable treatment option for LBP patients irrespective of their TS.
此前，我们观察到在慢性疼痛患者的混合群体中，单次针灸治疗后疼痛立即减轻与无痛对照部位的高疼痛时间总和（TS）以及较年轻的年龄有关。本研究的目的是在慢性非特异性下腰痛（LBP）患者中验证这些结果，并收集关于TS与一系列针灸治疗反应之间关联的初步数据。
通过针刺诱发的累积比率（WUR）对60名年龄在50岁及以下的LBP患者无痛对照部位（优势手背部）和疼痛部位的TS进行量化。通过疼痛部位的疼痛强度变化和压力疼痛阈值（PPT）评估单次针灸治疗的反应。主要假设是高TS（WUR＞2.5）将与疼痛强度至少降低30%的临床相关降低相关。在研究的第二部分，26名患者接受了另外9次治疗。通过最后一周的疼痛强度、PPT和汉诺威功能能力问卷（FFbH-R）评估对一系列针灸治疗的反应。
无论对照部位的TS如何，疼痛强度立即降低至少30%的情况很常见（低TS与高TS分别为58%对72%，P=0.266）。疼痛部位的高TS也与疼痛强度的临床相关立即降低无显著关联（低TS与高TS分别为46%对73%，P=0.064）。单次针灸治疗后PPT没有变化。研究的第二部分没有揭示对照部位的TS与任何结果指标之间的一致关联，但也有一个趋势，即疼痛部位的低TS与临床相关反应的可能性更高。
我们的结果并不表明TS在预测慢性非特异性LBP患者的临床重要针灸效果或对10次针灸治疗系列的反应中起重要作用。总体较高的反应率表明，针灸是LBP患者的一种合适治疗选择，无论其TS如何。
