Brena Steven F, Wolf Steven L, Chapman Stanley L, Hammonds William D
Department of Rehabilitation Medicine, Pain Control Center, Emory University, Atlanta, Ga. 30322 U.S.A.
Pain. 1980 Feb;8(1):1-10. doi: 10.1016/0304-3959(80)90085-8.
Twenty patients with chronic low back pain received 12 lumbar sympathetic injections, in a series of 6 with bupivacaine and a series of 6 with saline. Changes in subjective pain intensity, EMG from paravertebral muscles, joint ranges of mobility, and daily activity levels were measured at multiple intervals throughout treatment and at 3 monthly follow-up intervals. The MMPI was administered before treatment, after treatment and at 3-month follow-up. Results revealed significant reductions in subjective pain intensity lasting 1 month after treatment which were not significantly different during bupivacaine and saline injection periods. Patients' MMPI profiles were indicative of reduced depression and an increase in ability to manage their lives. No significant changes were recorded with respect to EMG, joint range of mobility, or daily activity levels. Results were discussed in terms of a massive placebo effect and analgesia obtained through hyperstimulation of various tissue structures. They are consistent with the hypothesis that central postsynaptic mechanisms were predominant in these patients' chronic back pain states. Because subjective pain relief did not independently produce increasing function, it was recommended that deep analgesic injections or other pain relieving techniques be matched with behavior modification leading to functional rehabilitation.
20名慢性下背痛患者接受了12次腰交感神经注射，其中6次注射布比卡因，6次注射生理盐水。在整个治疗过程中的多个时间点以及3个月的随访间隔期，测量主观疼痛强度、椎旁肌肌电图、关节活动范围和日常活动水平的变化。在治疗前、治疗后以及3个月随访时进行明尼苏达多相人格调查表（MMPI）测试。结果显示，治疗后主观疼痛强度显著降低，持续1个月，在布比卡因和生理盐水注射期间无显著差异。患者的MMPI剖面图表明抑郁减轻，生活自理能力增强。肌电图、关节活动范围或日常活动水平方面未记录到显著变化。从大规模安慰剂效应以及通过对各种组织结构的过度刺激获得镇痛效果的角度对结果进行了讨论。这些结果与以下假设一致，即在这些患者的慢性背痛状态中，中枢突触后机制占主导地位。由于主观疼痛缓解并未独立导致功能增强，因此建议将深部镇痛注射或其他止痛技术与导致功能康复的行为矫正相结合。
