Sabater-Gárriz Álvaro, Cerón José Joaquín, Montoya Pedro, Riquelme Inmaculada
Balearic ASPACE Foundation, Marratxí, Spain.
Research Institute on Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain.
PLoS One. 2024 Dec 27;19(12):e0308386. doi: 10.1371/journal.pone.0308386. eCollection 2024.
Pain in people with cerebral palsy (CP) has been classically underestimated and poorly treated, particularly in individuals with impaired communication skills.
To analyze changes in different salivary metabolites and pain behavior scales after a painful procedure in adults with CP and adults with typical development.
Salivary levels of sTNF-α, sIgA, Cortisol, FRAP, ADA and Alpha Amylase, as well as 3 observational pain scales (Wong-Baker, Non-Communicating Adults Pain Checklist and Facial Action Coding System) were assessed before and after an intramuscular injection in 30 Individuals with CP and 30 healthy controls. Video recording of face expression was performed during the procedure for offline analysis.
Pain in subjects with CP was higher than in healthy controls after the intramuscular injection as displayed by observational scales. sTNF-α experienced a significant post-stimulus increase in both groups and that increase shows a tendency to correlate with the observational scales scores. Other biomarkers classically associated with stress (cortisol, Alpha Amylase) remain stable.
sTNF-α might be a promising pain indicator. Further research using controlled painful stimuli of greater intensity and pain self-reports, would be necessary to better understand its use as a pain biomarker.
脑瘫（CP）患者的疼痛一直以来都被严重低估且治疗不佳，尤其是对于沟通能力受损的个体。
分析成年脑瘫患者和发育正常的成年人在经历一次疼痛操作后，不同唾液代谢物和疼痛行为量表的变化。
在30名脑瘫患者和30名健康对照者进行肌肉注射前后，评估唾液中sTNF-α、sIgA、皮质醇、FRAP、ADA和α淀粉酶的水平，以及3种观察性疼痛量表（面部表情疼痛量表、非言语成人疼痛检查表和面部动作编码系统）。在操作过程中进行面部表情视频记录以便离线分析。
观察量表显示，肌肉注射后，脑瘫患者的疼痛程度高于健康对照者。两组中sTNF-α在刺激后均显著增加，且这种增加显示出与观察量表评分相关的趋势。其他传统上与应激相关的生物标志物（皮质醇、α淀粉酶）保持稳定。
sTNF-α可能是一种有前景的疼痛指标。需要进一步开展使用强度更大的可控疼痛刺激和疼痛自我报告的研究，以更好地理解其作为疼痛生物标志物的用途。
