Low back pain may be caused by disturbed pain regulation A cross-sectional study in low back pain patients using tender point examination
Low back pain may be caused by disturbed pain regulation A cross-sectional study in low back pain patients using tender point examination
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DOI：
10.1016/j.ejpain.2009.09.002
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发表时间：
2010-05-01
影响因子：
3.6
通讯作者：
Stengaard-Pedersen, Kristian
中科院分区：
文献类型：
--
作者：
Jensen, Ole Kudsk;Nielsen, Claus Vinther;Stengaard-Pedersen, Kristian
背景：广泛的疼痛对腰痛（LBP）患者的预后有负面影响。压痛点（TP）检查是评估弥漫性压痛的标准化检查方法。目的：通过标准化TP检查评估弥漫性压痛，并分析TP数量与脊柱结构变化以及心理社会因素之间的关系。方法：患者因LBP伴或不伴坐骨神经痛而患病3-16周，完成问卷调查，并进行临床下背部检查和TP检查。在326例患者中，111例证实有神经根病变，215例有非特异性LBP伴或不伴放射痛。结果：多因素Logistic回归分析显示，8个以上TP与椎间盘退变呈显著负相关（比值比（OR）0.58（0.40-84），95%置信区间（CI）：0.39-0.84，p = 0.004），并证实神经根受累（OR 0.15（0.04-0.54），p = 0.004），与LBP首次发作后的年数呈正相关（OR 1.05，CI：1.01-1.09，p = 0.009）。此外，超过8个TP与广泛疼痛，女性性别和身体不适呈正相关。所有患者包括，身体不适和压痛点的数量与LBP的强度呈正相关，但椎间盘退变与LBP的患者少于6 TPs.Conclusions：弥漫性压痛患者的疼痛很少与椎间盘退变或神经根的影响，而它可能是由扰乱疼痛调节。(C)2009年，国际疼痛分会研究协会欧洲联合会。由爱思唯尔有限公司出版。保留所有权利。
Background: Widespread pain has negative influence on outcome in low back pain (LBP) patients. Tender point (TP) examination is a standardized examination method to estimate diffuse tenderness.Aims: To assess diffuse tenderness by means of a standardized TP examination and to analyse for associations between the number of TPs and spinal structural changes as well as psycho-social factors.Methods: Patients sick-listed 3-16 weeks due to LBP with or without sciatica completed a questionnaire and went through a clinical low back examination and TP examination. Of 326 patients 111 had verified nerve root affection and 215 had non-specific LBP with or without radiating pain. Disc height reductions were estimated on lateral X-rays.Results: Multivariate logistic regression analysis showed that more than 8 TPs were strongly negatively associated with disc degeneration (Odds Ratio (OR) 0.58 (0.40-84), 95% Confidence Interval (CI): 0.39-0.84, p = 0.004) and verified nerve root affection (OR 0.15 (0.04-0.54), p = 0.004) and were positively associated with number of years since first episode of LBP (OR 1.05, CI: 1.01-1.09, p = 0.009). Furthermore, more than 8 TPs were positively associated with widespread pain, female sex and bodily distress. With all patients included, bodily distress and the number of tender points were positively associated with the intensity of LBP, but disc degeneration was only positively associated with LBP in patients with less than 6 TPs.Conclusions: The pain in patients with diffuse tenderness was rarely related to disc degeneration or nerve root affection, rather it may be caused by disturbed pain regulation. (C) 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.