Factors predicting the transition from acute to persistent pain in people with 'sciatica' - the FORECAST study

坐骨神经痛是一个术语，用于描述影响臀部，臀部和腿部的疼痛症状。它是由下背部的神经受伤或受到刺激引起的。坐骨神经痛可以感觉到热，尖锐，或电的性质。坐骨神经痛也会导致虚弱和发麻。坐骨神经痛是一种复杂的疾病，不同患者的疼痛可能由不同的机制引起。我们仍然不完全了解坐骨神经痛的确切机制。坐骨神经痛是一种非常常见的疾病，可能对日常生活产生破坏性影响。例如，一些患者失去了独立性，需要帮助完成日常任务，如穿衣。不幸的是，大约三分之一的坐骨神经痛患者会出现持续性坐骨神经痛。我们目前还不明白为什么有些患者会出现持续性坐骨神经痛，而有些患者会康复。以前的研究表明，通常的临床结果（例如，抑郁的存在或标准MRI扫描的变化）不能预测持续性坐骨神经痛疼痛。因此，需要一种不同的方法来识别可能发生持续性坐骨神经痛疼痛的患者。这就是FORECAST研究的目标。以前的研究仅包括简短的临床检查。我们的研究不同。我们将执行一组详细的测试（见下文）。我们的目标是，详细的测试可以预测谁会发展为持续性坐骨神经痛疼痛。我们计划在FORECAST研究中回答的问题是：1。这些详细的测试能识别出有类似机制导致坐骨神经痛的患者吗？2.下列哪些详细的测试可以预测持续性坐骨神经痛？FORECAST研究由牛津大学的一个由医生、神经科学家、统计学家和磁共振成像（MRI）专家组成的团队进行。该团队还包括患者合作伙伴。我们将邀请180名最近发生坐骨神经痛（<3个月）的患者参加FORECAST研究。在初步评估时，我们将进行详细的测试。这包括详细的感觉神经测试（定量感觉测试）。定量感觉测试评估患者对不同刺激（如冷、热或压力）的感觉。这告诉我们神经的工作情况以及它的敏感程度。我们还将包括一组精确的问卷，以评估疼痛类型（例如，烧伤或电击或疼痛）和情绪健康。当患者患有坐骨神经痛时，情绪健康会受到影响。例如，一些患者可能会焦虑或愤怒，其他人可能会感到孤独，并脱离朋友和家人。我们还将采取血液样本，以寻找炎症的迹象。在某些患者中，我们将使用专门的MRI扫描。这些图像比标准MRI扫描更详细和专业。它们使我们能够评估背部小神经的显微结构，这是标准MRI扫描无法实现的。这些详细的测试将为我们提供一个很好的图片的起点，病人的经验坐骨神经痛。然后，我们将再次联系病人三个月和一年后，问他们是否仍然有坐骨神经痛疼痛。我们将使用统计学来识别具有导致坐骨神经痛疼痛的相似机制的患者。我们还将研究哪些测试预测持续性坐骨神经痛疼痛。FORECAST研究的结果将帮助我们更好地了解坐骨神经痛的复杂性，以及谁将发展为持续性疼痛。我们的发现也将有助于未来的研究。例如，未来的研究可以检查我们是否可以通过对FORECAST研究显示可能发生持续性坐骨神经痛疼痛的患者进行更具体的治疗来预防或减少持续性疼痛。我们希望FORECAST研究的结果将有助于减少坐骨神经痛患者的痛苦并提高生活质量。

Sciatica is a term used to describe painful symptoms affecting the hips, buttocks and legs. It is caused by injured or irritated nerves in the lower back. Sciatica pain can feel hot, sharp, or electrical in nature. Sciatica can also cause weakness and pins and needles. Sciatica is a complex condition and the pain may be caused by different mechanisms in different patients. We still do not fully understand the exact mechanisms of sciatica pain. Sciatica is a very common condition and can have a devastating effect on everyday life. For example, some patients lose their independence and need help with day-to-day tasks such as dressing. Sadly, approximately one in three patients with sciatica develop persistent sciatica pain.We currently do not understand why some patients develop persistent sciatica pain and why some recover. Previous research has demonstrated that usual clinical findings (e.g., presence of depression or changes on a standard MRI scan) cannot predict persistent sciatica pain. Therefore a different approach is required to identify patients who may develop persistent sciatica pain. This is the goal of the FORECAST study. Previous studies only included a short clinical examination. Our study is different. We will perform a detailed set of tests (see below). Our ambition is that the detailed tests can predict who will develop persistent sciatica pain. The questions we plan to answer in the FORECAST study are: 1. Can the detailed tests identify patients with similar mechanisms causing their sciatica pain? 2. Which of these detailed tests predict persistent sciatica pain?The FORECAST study is performed by a team of medical doctors, neuroscientists, statisticians and magnetic resonance imaging (MRI) specialists at Oxford University. The team also includes patient partners. They help us to make sure our study is useful for patients.We will invite 180 patients with recent onset of sciatica pain (<3 months) to participate in the FORECAST study. At their initial assessment, we will perform the detailed tests. This includes detailed sensory nerve testing (quantitative sensory testing). Quantitative sensory testing evaluates how well patients can feel different stimulations such as cold, warm or pressure. This tells us how well the nerve is working and how sensitive it has become. We will also include a precise set of questionnaires to evaluate the types of pain (e.g., burning or electric shock or achy) and emotional wellbeing. Emotional wellbeing can be affected when a patient has sciatica. For instance, some patients may be anxious or angry, and others may feel lonely and detach themselves from friends and family. We will also take a blood sample to look for signs of inflammation. In some patients we will use specialised MRI scans. These images are much more detailed and specialised than standard MRI scans. They allow us to evaluate the microscopic structure of the small nerves in the back, which is not possible with standard MRI scans. These detailed tests will provide us with a good picture of the starting point of a patient's experience of sciatica.We will then contact patients again three months and one year later, to ask whether they still have sciatica pain. We will use statistics to identify patients with similar mechanisms causing their sciatica pain. We will also examine which tests predict persistent sciatica pain. The results of the FORECAST study will help us better understand the complexity of sciatica and who will develop persistent pain. Our findings will also help future research. For example, future studies can examine whether we can prevent or reduce persistent pain by giving more specific treatment to patients who the FORECAST study shows are likely to develop persistent sciatica pain. We hope that the results of the FORECAST study will help reduce suffering and improve quality of life for patients with sciatica.