Kutvonen O, Dastidar P, Nurmikko T
Department of Neurology, Tampere University Hospital, PL 2000, 33521 Tampere, Finland Department of Radiology, Tampere University Hospital, PL 2000, 33521 Tampere, Finland Pain Research Institute, The Walton Centre for Neurology and Neurosurgery NHS Trust, Rice Lane, Liverpool L9 1AE, UK.
Pain. 1997 Feb;69(3):279-286. doi: 10.1016/S0304-3959(96)03296-4.
Spasmodic torticollis (cervical dystonia) is frequently a painful condition but little is known of the characteristics of the pain. We assessed 39 patients with spasmodic torticollis for the presence or absence, location, and quality of pain, as well as its correlation to postural abnormality. Muscle tenderness was evaluated by manual palpation and pressure algometry. Measurements were made on muscles either actively maintaining or opposing abnormal head posture, as well as on muscles not contributing to it. Control measurements were made in 18 healthy subjects. Two-thirds of patients reported continuous or intermittent recurrent pain. Pain was reported widespread and diffuse over the neck and shoulders, with some radiation, predominantly on the side toward which the head was twisted. There were no differences between study groups when compared for pressure algometry and only moderate differences when compared for manual palpation. No correlation was found between the severity of motor signs and pain. Degenerative changes seen on X-rays were similar in painful and pain-free patients. These findings suggest that pain associated with spasmodic torticollis does not arise in muscles alone, and we hypothesise that central mechanisms are also involved.
痉挛性斜颈（颈部肌张力障碍）常常是一种疼痛性疾病，但对于其疼痛特征却知之甚少。我们评估了39例痉挛性斜颈患者疼痛的有无、部位、性质，以及疼痛与姿势异常的相关性。通过手法触诊和压力痛觉测定法评估肌肉压痛情况。对主动维持或对抗异常头部姿势的肌肉以及与之无关的肌肉进行测量。对18名健康受试者进行对照测量。三分之二的患者报告有持续性或间歇性反复疼痛。据报告，疼痛广泛弥漫于颈部和肩部，有一些放射痛，主要集中在头部扭转方向的一侧。在压力痛觉测定方面，研究组之间无差异，在手法触诊方面仅有中度差异。未发现运动体征严重程度与疼痛之间存在相关性。在有疼痛和无疼痛的患者中，X线显示的退行性改变相似。这些发现表明，与痉挛性斜颈相关的疼痛并非仅源于肌肉，我们推测中枢机制也参与其中。
