Chronic pain and sensorimotor deficits following peripheral nerve injury
Chronic pain and sensorimotor deficits following peripheral nerve injury
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DOI：
10.1016/j.pain.2010.06.032
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发表时间：
2010-12-01
期刊：
影响因子：
7.4
通讯作者：
Davis, Karen D.
中科院分区：
文献类型：
--
作者：
Taylor, Keri S.;Anastakis, Dimitri J.;Davis, Karen D.
上肢周围神经横断和手术修复（PNIr）后，患者经常表现出感觉和运动缺陷，但只有一些患者出现慢性神经性疼痛。因此，PNIr 的感觉运动结果可能会受到个体因素的影响。因此，我们的目的是确定 PNIr 后患有慢性神经性疼痛 (PNI-P) 的患者是否能够通过疼痛灾难化、神经质或外向性等心理因素与无疼痛患者 (PNI-NP) 和健康对照 (HC) 区分开来，以及 (2) 比没有出现慢性疼痛的患者 (PNI-NP) 表现出更严重的感觉运动缺陷。 31 名正中神经和/或尺神经完全切断的患者（21 名 PNI-NP、10 名 PNI-P）和 21 名 HC 完成了问卷以评估疼痛特征、疼痛灾难性、神经质和外向性，并接受了感觉运动评估。神经传导研究揭示了基于横断神经中异常的感觉和运动潜伏期和振幅测量的不完全感觉运动外周恢复。患者的感觉功能（两点辨别以及振动、触摸和温暖检测）、感觉运动整合和精细运动灵活性也有明显缺陷。与 PNI-NP 患者相比，PNI-P 患者的振动检测阈值更高，感觉运动整合任务表现更差，运动障碍更严重，神经传导受损更严重。此外，PNI-P 患者在冷加压试验中的冷痛耐受性降低、疼痛强度和不愉快程度升高，并且在神经质和疼痛灾难化量表上得分较高。这些数据表明，PNIr 后的慢性神经性疼痛与神经再生受损、严重的感觉运动缺陷和不同的心理特征有关，这些心理特征可能预示着损伤后恢复不良。 (C) 2010 年国际疼痛研究协会。由 Elsevier B.V. 出版。保留所有权利。
Following upper limb peripheral nerve transection and surgical repair (PNIr) patients frequently exhibit sensory and motor deficits, but only some develop chronic neuropathic pain. Thus, the sensorimotor outcome of PNIr may be impacted by individual factors. Therefore, our aims were to determine if patients with chronic neuropathic pain (PNI-P) following PNIr (1) are distinguished from patients without pain (PNI-NP) and healthy controls (HCs) by the psychological factors of pain catastrophizing, neuroticism or extraversion, and (2) exhibit more severe sensorimotor deficits than patients who did not develop chronic pain (PNI-NP). Thirty-one patients with complete median and/or ulnar nerve transection (21 PNI-NP, 10 PNI-P) and 21 HCs completed questionnaires to assess pain characteristics, pain catastrophizing, neuroticism and extraversion and underwent sensorimotor evaluation. Nerve conduction studies revealed incomplete sensorimotor peripheral recovery based on abnormal sensory and motor latency and amplitude measures in transected nerves. The patients also had significant deficits of sensory function (two-point discrimination and vibration, touch, and warmth detection), sensorimotor integration, and fine motor dexterity. Compared to PNI-NP patients, PNI-P patients had higher vibration detection thresholds, performed worse on sensory-motor integration tasks, had greater motor impairment, and showed more impaired nerve conduction. Furthermore, PNI-P patients had reduced cold pain tolerance, elevated pain intensity and unpleasantness during the cold pressor test, and they scored higher on neuroticism and pain-catastrophizing scales. These data demonstrate that chronic neuropathic pain following PNIr is associated with impaired nerve regeneration, profound sensorimotor deficits and a different psychological profile that may be predictive of poor recovery after injury. (C) 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.