Lima Pessôa Bruno, Davidovich Eduardo, Nascimento Osvaldo, Hauwanga Wilhelmina N, McBenedict Billy
Neurosurgery, Fluminense Federal University, Niterói, BRA.
Neurology, Fluminense Federal University, Niterói, BRA.
Cureus. 2025 Mar 6;17(3):e80174. doi: 10.7759/cureus.80174. eCollection 2025 Mar.
Persistent spinal pain syndrome (PSPS) type 2 is a chronic condition characterized by low back pain, with or without radiating limb pain, persisting after spinal surgery. The underlying pathophysiology remains unclear, with potential contributions from altered central pain processing mechanisms.
This study investigates the role of central sensitization in PSPS using contact heat-evoked potentials (CHEPs), an electrophysiological tool for assessing spinothalamic tract integrity and central pain processing.
The study included 36 healthy controls and 15 PSPS patients with neuropathic pain (NP) localized to the L4, L5, and S1 dermatomes, stimulated at the L1 dermatome. CHEP parameters, including N2-P2 amplitude, N2 latency, and P2 latency, were compared between groups.
Significant differences were identified, with PSPS patients demonstrating prolonged N2 and P2 latencies (p=0.008 and p=0.005, respectively) and reduced N2-P2 amplitude (p=0.025). Receiver-operating characteristic (ROC) analyses revealed N2 latency as the most reliable diagnostic parameter (AUC=0.81, sensitivity 67%, specificity 80%). Approximately 68% of PSPS patients exhibited abnormal CHEP values, suggesting spinothalamic tract dysfunction.
These findings support the hypothesis of altered central pain processing in PSPS, consistent with previous studies on NP and central sensitization. However, no statistically significant correlation was observed between pain intensity (verbal rating scale) and CHEP parameters (p=0.06), potentially due to the limited sample size. CHEP is a valuable non-invasive tool for exploring central pain mechanisms in PSPS with potential diagnostic and therapeutic implications. Limitations include the small sample size and potential confounders, such as subclinical polyneuropathy in controls. Further research is recommended to complement these findings and explore the broader implications of central sensitization in PSPS and other chronic pain conditions.
2型持续性脊柱疼痛综合征（PSPS）是一种慢性疾病，其特征为下背部疼痛，伴有或不伴有肢体放射性疼痛，在脊柱手术后持续存在。潜在的病理生理学机制尚不清楚，可能与中枢性疼痛处理机制改变有关。
本研究使用接触热诱发电位（CHEPs）来研究中枢敏化在PSPS中的作用，CHEPs是一种用于评估脊髓丘脑束完整性和中枢性疼痛处理的电生理工具。
该研究纳入了36名健康对照者和15名PSPS患者，这些患者的神经性疼痛（NP）局限于L4、L5和S1皮节，在L1皮节进行刺激。比较了两组之间的CHEP参数，包括N2-P2波幅、N2潜伏期和P2潜伏期。
发现了显著差异，PSPS患者的N2和P2潜伏期延长（分别为p = 0.008和p = 0.005），N2-P2波幅降低（p = 0.025）。受试者操作特征（ROC）分析显示，N2潜伏期是最可靠的诊断参数（曲线下面积[AUC]=0.81，敏感性67%，特异性80%）。约68%的PSPS患者表现出异常的CHEP值，提示脊髓丘脑束功能障碍。
这些发现支持了PSPS中中枢性疼痛处理改变的假说，这与先前关于NP和中枢敏化的研究一致。然而，未观察到疼痛强度（视觉模拟评分）与CHEP参数之间存在统计学显著相关性（p = 0.06），这可能是由于样本量有限。CHEPs是一种有价值的非侵入性工具，可用于探索PSPS中的中枢性疼痛机制，具有潜在的诊断和治疗意义。局限性包括样本量小和潜在的混杂因素，如对照组中的亚临床多发性神经病。建议进一步研究以补充这些发现，并探索中枢敏化在PSPS和其他慢性疼痛疾病中的更广泛意义。
