Smythe H A
University of Toronto Rheumatic Disease Unit, ON, Canada.
J Rheumatol. 1994 Aug;21(8):1520-6.
(1) To confirm association of marked tenderness at the coracoid tip, lateral pectoral and medial elbow sites, with tenderness at the C6-7 level in the cervical spine. This had been observed in subjects with prior neck pain, who lost tenderness at C5-6 and standard upper body sites with neck support during sleep, but remained symptomatic; (2) to document apparent risk and prognostic factors; (3) to observe the effects of a modified treatment strategy.
A protocol including possible risk and prognostic factors was developed, and a case series assembled. Findings on entry tested the hypothesized pattern of linked tender sites. Subjects consenting to followup became a cohort in which outcomes were studied.
In 151 subjects, there were associations among the tenderness scores (mean r value of 0.59, p < 0.001) of points in the 6-7 group on the same side, an intermediate level of association with contralateral but homologous points (mean r value of 0.31), but weak associations (mean r value 0.07) with contralateral and different points. During followup, 47% obtained marked or complete relief at their first followup visit, and a final followup (median 18 months), 84% of those without previous fibromyalgia (FM) achieved this satisfactory outcome, and 63% of those with prior FM.
This experience supports the hypothesis that mechanical factors determine patterns of symptoms and tenderness in many subjects with regional and general pain syndromes, and points to new strategies of diagnosis and treatment which may be critical for success.
（1）证实喙突尖、胸大肌外侧和肘内侧部位的明显压痛与颈椎C6 - 7水平压痛之间的关联。这一现象在既往有颈部疼痛的受试者中被观察到，这些受试者在睡眠时使用颈部支撑后，C5 - 6和标准上身部位的压痛消失，但仍有症状；（2）记录明显的风险和预后因素；（3）观察改良治疗策略的效果。
制定了一个包括可能的风险和预后因素的方案，并收集了一系列病例。入组时的检查结果对假设的相关压痛点模式进行了验证。同意随访的受试者组成了一个队列，对其结果进行研究。
在151名受试者中，同侧6 - 7组各点的压痛评分之间存在关联（平均r值为0.59，p < 0.001），与对侧但同源点的关联处于中等水平（平均r值为0.31），而与对侧不同点的关联较弱（平均r值为0.07）。在随访期间，47%的受试者在首次随访时获得了明显或完全缓解，在最后一次随访（中位时间18个月）时，既往无纤维肌痛（FM）的受试者中有84%取得了满意的结果，既往有FM的受试者中有63%取得了满意的结果。
这一经验支持了这样一种假设，即机械因素决定了许多患有局部和全身性疼痛综合征的受试者的症状和压痛模式，并指出了可能对成功至关重要的新的诊断和治疗策略。
