An etiological paradigm shift for chronic hemiplegic shoulder pain.
An etiological paradigm shift for chronic hemiplegic shoulder pain.
复制标题
慢性偏瘫肩痛的病因学范式转变。
DOI：
10.1097/phm.0000000000000161
复制
发表时间：
2014
影响因子：
3
通讯作者：
Wilson,RichardD
中科院分区：
文献类型：
--
作者：
Wilson,RichardD
我们感谢对最近发表的手稿的兴趣，“外周神经刺激与偏瘫肩痛疼痛缓解的康复护理比较”。1这项研究提供的证据表明，周围神经刺激（PNS）是一种有效的治疗偏瘫肩痛（HSP），并减少疼痛的程度更大，比常规护理的持久性更长。已经正确地指出，研究作者没有试图根据伤害性和生物力学模型来诊断HSP的发生。这不是一个疏忽，而是由于另一种关于慢性HSP病因学的思维范式被认为与急性HSP的病因学不同。也就是说，HSP最初可能是31种或更多HSP直接原因之一的结果，但中枢神经系统的适应不良变化是导致疼痛持续超过初始损伤的原因。很明显，成像研究中可识别的病理与HSP的存在具有低相关性。2-4此外，有越来越多的证据表明，伤害性和生物力学模型应重新考虑在慢性HSP的病因学中枢致敏过程的青睐。5-8由于队列的异质性，研究结果无效的说法值得重新审查。本研究的设计包括随机治疗分配，因此治疗状态不会受到测量或未测量的基线特征的混淆。9对基线人口统计学资料（表1）的审查表明，随机化程序按预期进行，即使在本研究中样本量较小的情况下，也能创建平衡良好的队列。1没有迹象表明缺乏平衡，这一点得到了信中承认的支持，即盂肱关节半脱位在两个队列中的发生比例相似。因此，结果应被视为有效，而不是偶然的。
We appreciate the interest in the recently published manuscript,“Peripheral Nerve Stimulation Compared with Usual Care for Pain Relief of Hemiplegic Shoulder Pain.” 1 This study provides evidence that peripheral nerve stimulation (PNS) is an efficacious treatment for hemiplegic shoulder pain (HSP) and reduces pain to a greater extent and with longer durability than usual care. It has been correctly pointed out that there was no attempt by the study authors to provide a diagnosis for the occurrence of HSP based on the nociceptive and biomechanical models. This was not an oversight, rather is due to an alternative paradigm of thought regarding the etiology of chronic HSP considered to be distinct from the etiology of acute HSP. That is, HSP may initially be the result of one of the 31 or more of the direct causes of HSP, but maladaptive changes in the central nervous system are responsible for the pain persisting beyond the initial injury. It is apparent that identifiable pathologies on imaging studies have low correlation to the presence of HSP. 2-4 Furthermore, there is a growing body of evidence to suggest that the nociceptive and biomechanical models should be reconsidered in favor of a central sensitization process in the etiology of chronic HSP. 5-8The assertion that the study results are not valid due to heterogeneity of the cohorts deserves reexamination. The design of this study included randomized treatment allocation so that treatment status would not be confounded by either measured or unmeasured baseline characteristics. 9 A review of baseline demographics (Table 1) indicates that the randomization procedure performed as expected to create well-balanced cohorts, even with the small sample sizes in this study. 1 There is no indication of lack of balance, and this is supported by the acknowledgement in the letter that glenohumeral subluxation occurs in similar proportions in both of the cohorts. Thus, the results should be considered valid and not due to chance.
登录
查看更多内容
DOI：
10.1073/pnas.72.5.1649
发表时间：
1975
影响因子：
11.1
作者：
L. Sklar;B. Hudson;R. D. Simoni
通讯作者：
R. D. Simoni
胆固醇浓度对病毒和囊泡膜组织的影响。
影响因子：
4.8
作者：
R. Pal;Y. Barenholz;R. Wagner
通讯作者：
R. Wagner
DOI：
--
发表时间：
1981
期刊：
Molecular biology, biochemistry, and biophysics
影响因子：
--
作者：
J. Yguerabide;M. C. Foster
通讯作者：
M. C. Foster
表面曲率对磷脂双层囊泡头基结构和相变特性的影响。
DOI：
--
发表时间：
1980
期刊：
Biochimica et Biophysica Acta
影响因子：
--
作者：
K. E. Eigenberg;S. Chan
通讯作者：
S. Chan
作为模型膜系统的包膜病毒：水泡性口炎病毒和宿主细胞膜的微粘度。
影响因子：
2.9
作者：
Y. Barenholz;N. Moore;R. Wagner
通讯作者：
R. Wagner