Bilateral Sensory Changes and High Burden of Disease in Patients With Chronic Pain and Unilateral Nondermatomal Somatosensory Deficits: A Quantitative Sensory Testing and Clinical Study
Bilateral Sensory Changes and High Burden of Disease in Patients With Chronic Pain and Unilateral Nondermatomal Somatosensory Deficits: A Quantitative Sensory Testing and Clinical Study
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DOI：
10.1097/ajp.0000000000000456
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发表时间：
2017-08-01
影响因子：
2.9
通讯作者：
Riederer, Franz
中科院分区：
文献类型：
--
作者：
Landmann, Gunther;Dumat, Wolfgang;Riederer, Franz
目的：20% 至 40% 的慢性疼痛患者在疼痛一侧出现类似于偏侧感觉减退的广泛感觉缺陷，与疼痛病因无关，被称为非皮瘤感觉缺陷 (NDSD)。 NDSD 中的感觉特征很少进行研究。 材料和方法：根据德国神经性疼痛研究网络 (DFNS) 的协议，对慢性疼痛患者疼痛的身体一侧和对侧区域的面部、手和脚进行定量感觉测试。排除神经性疼痛后，纳入 25 名患有 NDSD 的患者和 23 名无 NDSD 的患者（称为仅疼痛组）。进行了全面的临床和精神病学评估。结果：慢性疼痛中的 NDSD 与高疾病负担和更广泛的疼痛相关。仅在 NDSD 组中，在疼痛同侧的 3 个区域中至少有 2 个区域发现机械和疼痛刺激的阈值显着升高。此外，我们发现 NDSD 患者的双侧温度和振动检测功能丧失，而某些区域的压痛功能获得增强。压痛的感觉丧失和功能获得与多个区域的疼痛强度相关。讨论：这可能表明慢性非神经性疼痛和 NDSD 具有独特的感觉特征，可能归因于中枢疼痛处理和敏化的改变。慢性非神经性疼痛中 NDSD 的存在可被视为疼痛疾病负担较高的标志。
Objectives:Widespread sensory deficits resembling hemihypoesthesia occur in 20% to 40% of chronic pain patients on the side of pain, independent of pain etiology, and have been termed nondermatomal sensory deficits (NDSDs). Sensory profiles have rarely been investigated in NDSDs.Materials and Methods:Quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS) was performed in the face, hand, and foot of the painful body side and in contralateral regions in chronic pain patients. Twenty-five patients with NDSDs and 23 without NDSDs (termed the pain-only group) were included after exclusion of neuropathic pain. Comprehensive clinical and psychiatric evaluations were carried out.Results:NDSD in chronic pain was associated with high burden of disease and more widespread pain. Only in the NDSD group were significantly higher thresholds for mechanical and painful stimuli found in at least 2 of 3 regions ipsilateral to pain. In addition, we found a bilateral loss of function for temperature and vibration detection, and a gain of function for pressure pain in certain regions in patients with NDSD. Sensory loss and gain of function for pressure pain correlated with pain intensity in several regions.Discussion:This may indicate a distinct sensory profile in chronic non-neuropathic pain and NDSD, probably attributable to altered central pain processing and sensitization. The presence of NDSD in chronic non-neuropathic pain may be regarded as a marker for higher burden of pain disease.