Nonorganic (Behavioral) Signs and Their Association With Epidural Corticosteroid Injection Treatment Outcomes and Psychiatric Comorbidity in Cervical Radiculopathy: A Multicenter Study.
Nonorganic (Behavioral) Signs and Their Association With Epidural Corticosteroid Injection Treatment Outcomes and Psychiatric Comorbidity in Cervical Radiculopathy: A Multicenter Study.
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非器质性（行为）体征及其与硬膜外皮质类固醇注射治疗结果和颈椎神经根病精神合并症的关联：一项多中心研究。
DOI：
10.1016/j.mayocp.2022.11.022
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发表时间：
2023
影响因子：
8.9
通讯作者：
Moon,JeeYoun
中科院分区：
文献类型：
--
作者：
Cohen,StevenP;Doshi,TinaL;Dolomisiewicz,Edward;Reece,DavidE;Zhao,Zirong;Anderson-White,Mirinda;Kasuke,Angelia;Wang,EricJ;Hsu,Annie;Davis,SheltonA;Yoo,Yongjae;Pasquina,PaulF;Moon,JeeYoun
目的探讨宫颈非器质性疼痛体征与硬膜外皮质类固醇注射结局及并发疼痛和精神疾病的关系。患者和方法对78例接受硬膜外皮质类固醇注射的颈椎病患者进行观察，以确定非器质性体征对治疗结果的影响。积极的结果是平均手臂疼痛减少2分或更多，加上治疗后4周患者总体印象变化量表7分得分为5分。5类9项试验（异常压痛、偏离正常解剖结构的局部紊乱、过度反应、分散检查结果差异、假刺激时疼痛）在以往研究的基础上进行了修改和标准化。其他与非器质性体征和结果相关的变量包括疾病负担、精神病理、共存疼痛状况和躯体化。结果78例患者中，29% （n=23）无非器质性体征，21% （n=16）有1类体征，10% （n=8）有2类体征，21% （n=16）有3类体征，10% （n=8）有4类体征，9% （n=7）有5类体征。最常见的非器质性体征是浅表压痛（44%;n=34）。阴性治疗结果个体阳性非有机分类的平均数量（2.5±1.8;95% CI， 2.0至3.1）高于阳性治疗结果个体（1.1±1.3;95% CI， 0.7至1.5；P= 0.0002）。负面治疗结果与局部紊乱和过度反应密切相关。非器质性症状与多重疼痛（P= 0.011）和多重精神疾病（P= 0.028）呈正相关。结论宫颈非器质性体征与治疗结果、疼痛和精神合并症相关。筛查这些体征和精神症状可以改善治疗效果。临床试验注册号：NCT04320836。
ObjectiveTo determine the association between cervical nonorganic pain signs and epidural corticosteroid injection outcomes and coexisting pain and psychiatric conditions.Patients and MethodsSeventy-eight patients with cervical radiculopathy who received epidural corticosteroid injection were observed to determine the effects that nonorganic signs have on treatment outcome. A positive outcome was a decrease of 2 or more points in average arm pain, coupled with a score of 5 on a 7-point Patient Global Impression of Change scale 4 weeks after treatment. Nine tests in 5 categories (abnormal tenderness, regional disturbances deviating from normal anatomy, overreaction, discrepancies in examination findings with distraction, and pain during sham stimulation) were modified from previous studies and standardized. Other variables examined for their association with nonorganic signs and outcomes included disease burden, psychopathology, coexisting pain conditions, and somatization.ResultsOf the 78 patients, 29% (n=23) had no nonorganic signs, 21% (n=16) had signs in 1 category, 10% (n=8) had signs in 2 categories, 21% (n=16) had signs in 3 categories, 10% (n=8) had signs in 4 categories, and 9% (n=7) had signs in 5 categories. The most common nonorganic sign was superficial tenderness (44%; n=34). Mean number of positive nonorganic categories was higher in individuals with negative treatment outcomes (2.5±1.8; 95% CI, 2.0 to 3.1) compared with those with positive outcomes (1.1±1.3; 95% CI, 0.7 to 1.5;P=.0002). Negative treatment outcomes were most strongly associated with regional disturbances and overreaction. Positive associations were noted between nonorganic signs and multiple pain (P=.011) and multiple psychiatric (P=.028) conditions.ConclusionCervical nonorganic signs correlate with treatment outcome, pain, and psychiatric comorbidities. Screening for these signs and psychiatric symptoms may improve treatment outcomes.Trial RegistrationClinicalTrials.gov identifier: NCT04320836.
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DOI：
10.2519/jospt.2014.4715
发表时间：
2014
期刊：
The Journal of orthopaedic and sports physical therapy
影响因子：
--
作者：
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DOI：
10.1097/phm.0b013e3181f70eae
发表时间：
2010
影响因子：
3
作者：
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影响因子：
8.8
作者：
Cohen, Steven P.;Hayek, Salim;Vorobeychik, Yakov
通讯作者：
Vorobeychik, Yakov
影响因子：
2.9
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JAMISON, RN;VADEBONCOUER, T;FERRANTE, FM
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FERRANTE, FM
影响因子：
3
作者：
Swinkels, Raymond A. H. M.;Swinkels-Meewisse, Ilse E. J. C. M.
通讯作者：
Swinkels-Meewisse, Ilse E. J. C. M.