Barbosa Franco Sara, Di-Bonaventura Silvia, Pacheco-Barrios Kevin, Sugugawara Andre, Imamura Marta, Yoshioka Leandro Heidy, Battistella Linamara, Fregni Felipe
Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
Br J Pain. 2025 Apr 22:20494637251336359. doi: 10.1177/20494637251336359.
BACKGROUND: Amputation leads to significant physical, psychological, and emotional challenges, with chronic pain being among the most debilitating outcomes. Conditioned Pain Modulation (CPM) is a key mechanism for understanding pain modulation reflecting the central nervous system's capacity to regulate pain. OBJECTIVE: This study aimed to evaluate CPM in amputees, comparing CPM between the amputated and non-amputated sides, and to identify factors influencing CPM in this population. METHOD: Eighty-six amputees participated in the study. Sociodemographic and pain-related variables, including age, occupation, smoking status, pre-amputation pain duration, phantom limb pain, and pressure pain threshold, were assessed. Multiple linear regression models were performed to explore factors associated with CPM on both sides, with additional -tests to compare CPM values between sides. RESULTS: The multivariate model for the amputated side explained 26.3% of CPM variability, with significant associations found for pre-amputation pain duration and retirement status, as well as PPT mean of the amputated side, smoking, and phantom limb pain and age. In contrast, the non-amputated side model explained 26.5% (Adjusted R-squared) of the variability, with the following significant variables: duration of pre-amputation pain (negative correlation), smoking history, phantom limb pain (negative correlation), and frequency of telescoping sensation (negative correlation). There were no significant differences in CPM between amputated and non-amputated sides ( > 0.05). CONCLUSION: The findings suggest that CPM on the amputated side is more influenced by pain experience and sociodemographic variables, while the non-amputated side shows less variability and is more resilient to these influences.
背景:截肢会带来重大的身体、心理和情感挑战,慢性疼痛是最使人衰弱的后果之一。条件性疼痛调制(CPM)是理解疼痛调制的关键机制,反映了中枢神经系统调节疼痛的能力。 目的:本研究旨在评估截肢者的CPM,比较截肢侧与非截肢侧的CPM,并确定影响该人群CPM的因素。 方法:86名截肢者参与了本研究。评估了社会人口统计学和疼痛相关变量,包括年龄、职业、吸烟状况、截肢前疼痛持续时间、幻肢痛和压力痛阈值。进行多元线性回归模型以探索与两侧CPM相关的因素,并进行额外的检验以比较两侧的CPM值。 结果:截肢侧的多变量模型解释了CPM变异性的26.3%,发现截肢前疼痛持续时间和退休状态以及截肢侧的PPT平均值、吸烟、幻肢痛和年龄之间存在显著关联。相比之下,非截肢侧模型解释了26.5%(调整后R平方)的变异性,显著变量如下:截肢前疼痛持续时间(负相关)、吸烟史、幻肢痛(负相关)和套叠感频率(负相关)。截肢侧与非截肢侧的CPM无显著差异(P>0.05)。 结论:研究结果表明,截肢侧的CPM受疼痛经历和社会人口统计学变量的影响更大,而非截肢侧的变异性较小,对这些影响更具弹性。
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