Spatial Pain Propagation Over Time Following Painful Glutamate Activation of Latent Myofascial Trigger Points in Humans
Spatial Pain Propagation Over Time Following Painful Glutamate Activation of Latent Myofascial Trigger Points in Humans
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DOI：
10.1016/j.jpain.2012.03.001
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发表时间：
2012-06-01
期刊：
影响因子：
4
通讯作者：
Arendt-Nielsen, Lars
中科院分区：
文献类型：
--
作者：
Wang, Chao;Ge, Hong-You;Arendt-Nielsen, Lars
本研究的目的是验证一种假说，即紧张性伤害性刺激潜在的肌筋膜触发点(MTP)可能会导致压痛性痛觉过敏的空间面积扩大。前臂潜伏期和非潜伏期的MTP均通过肌电图仪引导的方法获得疼痛的谷氨酸(2.2mL，1M)刺激。记录注射谷氨酸后的疼痛强度(视觉模拟评分[VAS])和牵涉疼痛面积。分别于注射谷氨酸前、注射谷氨酸后0.5小时、1小时和24小时测量前臂肌肉和胫前肌中点的压痛阈值(PPT)。结果表明，潜伏期MTP注射谷氨酸后，最大疼痛强度、VAS曲线下面积和牵涉痛面积均显著高于非MTP组(均P<0.05)。在前臂肌肉中注射谷氨酸后，潜伏期为0.5小时(4点)、1小时(7点)和24小时(6点)的PPT水平随时间延长而显著降低。然而，仅在将谷氨酸注射到前臂肌肉中的非MTP后24小时，PPT才显著低于注射前的PPT(4点，P<；0.05)。两组胫骨前中点PPT仅在注射后1小时较注射前显著降低(P<0.05)。本研究的结果表明，对潜伏性痛觉过敏的伤害性刺激与机械性痛敏局部扩大区域的早期出现有关。视角：本研究表明，与中枢敏化扩散相关的局部扩大的压力痛敏区域的早期发生有关。MTP的失活可能会阻止空间疼痛的传播。(C)2012年，美国疼痛协会
The aim of this present study was to test the hypothesis that tonic nociceptive stimulation of latent myofascial trigger points (MTPs) may induce a spatially enlarged area of pressure pain hyperalgesia. Painful glutamate (.2 mL, 1M) stimulation of latent MTPs and non-MTPs in the forearm was achieved by an electromyography-guided procedure. Pain intensity (as rated on the visual analog scale [VAS]) and referred pain area following glutamate injections were recorded. Pressure pain threshold (PPT) was measured over 12 points in the forearm muscles and at the mid-point of tibialis anterior muscle before and at .5 hour, 1 hour, and 24 hours after glutamate injections. The results showed that maximal pain intensity, the area under the VAS curve, and referred pain area were significantly higher and larger following glutamate injection into latent MTPs than non-MTPs (all, P < .05). A significantly lower PPT level was detected over time after glutamate injection into latent MTPs at .5 hour (at 4 points), 1 hour (at 7 points), and 24 hours (at 6 points) in the forearm muscles. However, a significantly lower PPT was observed only at 24 hours after glutamate injection into non-MTPs in the forearm muscles (at 4 points, P < .05) when compared to the pre-injection PPT. PPT at the mid-point of the tibialis anterior was significantly decreased at 1 hour only as compared to the pre-injection PPT in both groups (< .05). The results of the present study indicate that nociceptive stimulation of latent MTPs is associated with an early onset of locally enlarged area of mechanical hyperalgesia.Perspective: This study shows that MTPs are associated with an early occurrence of a locally enlarged area of pressure hyperalgesia associated with spreading central sensitization. Inactivation of MTPs may prevent spatial pain propagation. (C) 2012 by the American Pain Society