The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study.
The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study.
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DOI：
10.1186/s10194-020-01207-1
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发表时间：
2020-12-03
期刊：
影响因子：
--
通讯作者：
White FA
中科院分区：
文献类型：
--
作者：
Naugle KM;Carey C;Evans E;Saxe J;Overman R;White FA
创伤后头痛（PTH）是轻度创伤性脑损伤（TBI）后最常见且持续时间较长的症状之一。然而，持续性PTH发生发展的病理机制仍未完全明晰。这项前瞻性初步研究的主要目的，是评估轻度TBI后的早期疼痛调节特征（敏化作用和内源性疼痛抑制能力）以及心理因素，能否预测轻度TBI患者持续性PTH的发生。
从一级急诊科创伤中心招募的成年轻度TBI患者，在轻度TBI后的1 - 2周、1个月和4个月完成研究相关环节。参与者在每个环节完成以下结果测量：通过条件性疼痛调制测试测量内源性疼痛抑制能力，通过头部疼痛的时间总和以及头部压力痛阈值测量头部的敏化作用，同时完成疼痛灾难化量表、流调中心抑郁量表以及标准化头痛调查。根据4个月的数据，参与者被分为持续性PTH（PPTH）组和非PPTH组。
结果显示，与未发生持续性PTH的患者相比，发生持续性PTH的轻度TBI患者在受伤后表现出明显减弱的疼痛抑制能力，以及更严重的抑郁情绪和疼痛灾难化倾向。此外，逻辑回归分析表明，受伤后1 - 2周的头痛疼痛强度以及1 - 2周条件性疼痛调制测试中的疼痛抑制能力，能够预测受伤后4个月时是否会被归为持续性PTH类别。
总体而言，研究结果表明，持续性PTH的特点是在轻度TBI后的早期阶段，内源性疼痛调节功能和心理过程出现功能失调性改变，这很可能会增加PTH持续存在的风险。
Post-traumatic headache (PTH) is one of the most common and long-lasting symptoms following mild traumatic brain injury (TBI). However, the pathological mechanisms underlying the development of persistent PTH remain poorly understood. The primary purpose of this prospective pilot study was to evaluate whether early pain modulatory profiles (sensitization and endogenous pain inhibitory capacity) and psychological factors after mild TBI predict the development of persistent PTH in mild TBI patients. Adult mild TBI patients recruited from Level I Emergency Department Trauma Centers completed study sessions at 1–2 weeks, 1-month, and 4-months post mild TBI. Participants completed the following outcome measures during each session: conditioned pain modulation to measure endogenous pain inhibitory capacity, temporal summation of pain and pressure pain thresholds of the head to measure sensitization of the head, Pain Catastrophizing Scale, Center for Epidemiological Studies – Depression Scale, and a standardized headache survey. Participants were classified into persistent PTH (PPTH) and no-PPTH groups based on the 4-month data. The results revealed that mild TBI patients developing persistent PTH exhibited significantly diminished pain inhibitory capacity, and greater depression and pain catastrophizing following injury compared to those who do not develop persistent PTH. Furthermore, logistic regression indicated that headache pain intensity at 1–2 weeks and pain inhibitory capacity on the conditioned pain modulation test at 1–2 weeks predicted persistent PTH classification at 4 months post injury. Overall, the results suggested that persistent PTH is characterized by dysfunctional alterations in endogenous pain modulatory function and psychological processes in the early stages following mild TBI, which likely exacerbate risk for the maintenance of PTH.
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影响因子：
5
作者：
Lucas, Sylvia;Smith, Brendon M.;Hoffman, Jeanne M.
通讯作者：
Hoffman, Jeanne M.
影响因子：
2.4
作者：
Kraus, Jess;Hsu, Paul;Afifi, Abdelmonem A.
通讯作者：
Afifi, Abdelmonem A.
DOI：
10.1002/art.40752
发表时间：
2019-04
期刊：
Arthritis & rheumatology (Hoboken, N.J.)
影响因子：
--
作者：
Carlesso LC;Segal NA;Frey-Law L;Zhang Y;Na L;Nevitt M;Lewis CE;Neogi T
通讯作者：
Neogi T
影响因子：
--
作者：
Graven-Nielsen, T.;Wodehouse, T.;Kidd, B. L.
通讯作者：
Kidd, B. L.
影响因子：
2.1
作者：
Brown, Allen W.;Watanabe, Thomas K.;Dikmen, Sureyya
通讯作者：
Dikmen, Sureyya