Small fibre impairment predicts neuropathic pain in Guillain-Barre syndrome
Small fibre impairment predicts neuropathic pain in Guillain-Barre syndrome
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DOI：
10.1016/j.pain.2010.05.017
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发表时间：
2010-10-01
期刊：
影响因子：
7.4
通讯作者：
Attal, Nadine
中科院分区：
文献类型：
--
作者：
Martinez, Valeria;Fletcher, Dominique;Attal, Nadine
格林-巴利综合征（GBS）神经性疼痛（NP）的机制目前尚不清楚。最近的研究表明，GBS的急性神经病变不仅影响大髓鞘纤维，也影响小伤害纤维。在这项为期18个月的前瞻性纵向研究中，我们研究了小纤维损伤在GBS患者NP中的作用（n = 30）。通过量化冷热检测和疼痛阈值以及对阈以上疼痛热刺激和机械刺激的反应来评估小纤维。神经传导速度和机械检测阈值评估大髓鞘纤维。与15名健康对照相比，GBS患者的检测阈值，特别是下肢的检测阈值明显受损。GBS伴NP患者（n = 13）的足部冷检测阈值（p = 0.04）、热痛阈值（p = 0.03）和超阈热刺激反应（p = 0.017）较无疼痛或非神经性疼痛患者（n = 17）更严重。两组间大纤维功能障碍和运动障碍相似。急性期小纤维感觉损伤与烧灼痛强度相关（Rho: -0.72，冷检测p = 0.01; Rho: 0.72，热疼痛p = 0.02），并预测残余NP（热疼痛的比值为4.1 p = 0.04）。这些发现强调了GBS急性和慢性阶段NP中伤害性纤维损伤的重要性，并表明GBS中NP的机制与小纤维疼痛性感觉多发性神经病的机制相似。(C) 2010国际疼痛研究协会。Elsevier B.V.版权所有。
The mechanisms of neuropathic pain (NP) in Guillain Barre syndrome (GBS) are currently unknown. It has recently been shown that acute neuropathy of GBS not only affects large myelinated fibres but also small nociceptive fibres. In this prospective longitudinal 18 months study, we investigated the role of small fibre impairment in NP in GBS (n = 30). Small fibres were assessed by quantifying cold and warm detection and pain thresholds and responses to suprathreshold painful thermal and mechanical stimuli. Nerve conduction velocities and mechanical detection thresholds assessed large myelinated fibres. Detection thresholds particularly at the lower limbs were significantly impaired in patients with GBS compared to 15 healthy controls. GBS patients with NP(n = 13) had more severe impairment of cold detection thresholds (p = 0.04), heat pain thresholds (p = 0.03) and responses to suprathreshold heat stimuli (p = 0.017) in the foot compared with those without pain or with non-neuropathic pain (n = 17). Large fibre dysfunction and motor disability were similar between groups. Small fibre sensory impairment at the acute stage was correlated with the intensity of burning pain (Rho: -0.72; p = 0.01 for cold detection; Rho: 0.72; p = 0.02 for heat pain) and predicted residual NP (odds 4.1 p = 0.04 for heat pain). These findings emphasize the importance of nociceptive fibre impairment in NP in GBS at both acute and chronic stages and suggest similarities between the mechanisms of NP in GBS and those of small fibre painful sensory polyneuropathies. (C) 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.