Kapitza Camilla, Ballenberger Nikolaus, Luedtke Kerstin, Schmid Annina B, Tampin Brigitte
Faculty of Business, Management and Social Sciences, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany.
Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Luebeck, Institute of Health Sciences, Luebeck, Germany.
Pain. 2025 Feb 5;166(8):1784-1795. doi: 10.1097/j.pain.0000000000003516.
Spine-related neck-arm pain is heterogeneous and may present on a spectrum between nociceptive and neuropathic pain. A recently developed mechanism-based clinical framework for spine-related pain distinguishes between spinally referred pain without neurological deficits (somatic referred pain, heightened nerve mechanosensitivity, radicular pain), with neurological deficits (radiculopathy), and mixed-pain presentations. This study investigated differences in somatosensory and clinical profiles of patients with unilateral spine-related neck-arm pain grouped according to the clinical framework. Patients (n = 113) underwent a clinical examination, after which they were classified into a subgroup(s). They completed questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, pain catastrophizing scale, Depression, anxiety, and stress scale), neuropathic pain (Douleur neuropathique 4), and central sensitization features (Central Sensitization Inventory). Standardized quantitative sensory testing (QST) was performed over the maximal pain area and contralateral side. The radiculopathy group showed a significant loss of function on the symptomatic vs asymptomatic side in cold ( P = 0.024) and warm detection ( P = 0.004), thermal sensory limen ( P = 0.001), mechanical detection ( P = 0.001), increased windup ratio ( P = 0.014), and cold hyperalgesia ( P = 0.049). No other subgroup showed significant side differences in QST parameters. Symptom descriptors, such as burning ( P < 0.031), tingling ( P < 0.018), pins and needles ( P < 0.031), numbness ( P < 0.016), spontaneous pain ( P < 0.001), and electric pain/shock ( P < 0.026) were more common in the radicular/radiculopathy groups compared with the somatic/mechanosensitivity groups. There were no differences in psychosocial parameters between the groups. The phenotypic profiles support the construct of the clinical examination and patient classification and its application in clinical practice according to a clinical framework for spine-related pain.
脊柱相关性颈臂痛具有异质性，可能表现为伤害性疼痛和神经性疼痛之间的连续谱。最近开发的基于机制的脊柱相关性疼痛临床框架区分了无神经功能缺损的脊髓牵涉痛（躯体牵涉痛、神经机械敏感性增强、神经根性疼痛）、有神经功能缺损的情况（神经根病）以及混合性疼痛表现。本研究调查了根据该临床框架分组的单侧脊柱相关性颈臂痛患者的体感和临床特征差异。患者（n = 113）接受了临床检查，之后被分为一个或多个亚组。他们完成了问卷以评估功能（颈部功能障碍指数）、心理社会因素（坦帕运动恐惧量表、疼痛灾难化量表、抑郁、焦虑和压力量表）、神经性疼痛（神经病理性疼痛4）以及中枢敏化特征（中枢敏化量表）。在最大疼痛区域和对侧进行了标准化定量感觉测试（QST）。神经根病组在症状侧与无症状侧相比，在冷觉（P = 0.024）、温觉检测（P = 0.004）、热感觉阈（P = 0.001）、机械感觉检测（P = 0.001）、累积比率增加（P = 0.014）和冷痛觉过敏（P = 0.049）方面功能有显著丧失。没有其他亚组在QST参数上显示出显著的双侧差异。与躯体/机械敏感性亚组相比，神经根/神经根病亚组中诸如烧灼样（P < 0.031）、刺痛感（P < 0.018）、针刺感（P < 0.031）、麻木感（P < 0.016）、自发痛（P < 0.001）和电击样疼痛（P < 0.026）等症状描述更为常见。各组之间心理社会参数没有差异。表型特征支持临床检查和患者分类的构建及其在脊柱相关性疼痛临床框架下在临床实践中的应用。
