Axial low back pain: one painful area--many perceptions and mechanisms.
Axial low back pain: one painful area--many perceptions and mechanisms.
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DOI：
10.1371/journal.pone.0068273
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Baron R
中科院分区：
文献类型：
--
作者：
Förster M;Mahn F;Gockel U;Brosz M;Freynhagen R;Tölle TR;Baron R
轴性下腰痛可以被认为是一种同时包含伤害性和神经性疼痛成分(混合性疼痛)的综合征。特别是，神经性疼痛在实际经验中构成了治疗方面的挑战，并可能解释为什么背痛的药物治疗往往令患者和治疗师都失望。这项调查使用了来自横断面调查(Pain DETECT)的1083名轴性下腰痛患者的症状学流行病学和临床数据。目的是(1)评估神经病理性疼痛是否对轴性下腰痛有贡献，如果是，程度如何。(2)检测具有典型感觉症状的患者亚组，分析其人口学资料和合并症。(3)比较既往有无椎间盘手术(IVD)的患者。神经病理性疼痛成分可以在整个队列中检测到12%。对这些患者的聚类分析显示，五个不同的患者亚组显示出典型的感觉特征，即典型的症状星座和组合。所有的亚群都有相应的数量，有些表现出明显的神经病变特征，而另一些则表现出伤害性特征。与未做手术的患者相比，IVD手术后的患者表现出更多的“神经病理性”评分(无统计学意义)。轴性下腰痛在治疗方面有很高的并存率。从这些数据可以得出结论，与疼痛强度或单一诊断相比，基于描述符严重性的感觉特征可能是治疗评估的更好的预测因子。使用简单的工具对疼痛症状进行标准化表型可能有助于开发个性化治疗，从而在轴性下腰痛的药物治疗中获得更高的成功率。
Axial low back pain can be considered as a syndrome with both nociceptive and neuropathic pain components (mixed-pain). Especially neuropathic pain comprises a therapeutic challenge in practical experience and may explain why pharmacotherapy in back pain is often disappointing for both the patient and the therapist. This survey uses epidemiological and clinical data on the symptomatology of 1083 patients with axial low back pain from a cross sectional survey (painDETECT). Objectives were (1) to estimate whether neuropathic pain contributes to axial low back pain and if so to what extent. (2) To detect subgroups of patients with typical sensory symptom profiles and to analyse their demographic data and co-morbidities. (3) To compare patients with and without prior intervertebral disc surgery (IVD). Neuropathic pain components could be detected in 12% of the entire cohort. Cluster analyses of these patients revealed five distinct subgroups of patients showing a characteristic sensory profile, i.e. a typical constellation and combination of symptoms. All subgroups occurred in relevant numbers and some showed distinct neuropathic characteristics while others showed nociceptive features. Post-IVD-surgery patients showed a tendency to score more “neuropathic” than patients without surgery (not statistically significant). Axial low back pain has a high prevalence of co-morbidities with implication on therapeutic aspects. From these data it can be concluded that sensory profiles based on descriptor severity may serve as a better predictor for therapy assessment than pain intensity or sole diagnosis alone. Standardized phenotyping of pain symptoms with easy tools may help to develop an individualized therapy leading to a higher success rate in pharmacotherapy of axial low back pain.
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影响因子：
3.1
作者：
Fishbain, David A.;Lewis, John E.;Rosomoff, Rennee S.
通讯作者：
Rosomoff, Rennee S.
影响因子：
3.1
作者：
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通讯作者：
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影响因子：
7.4
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通讯作者：
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影响因子：
168.9
作者：
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通讯作者：
Jayson, MIV
影响因子：
7.4
作者：
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通讯作者：
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