Numbness in clinical and experimental pain - A cross-sectional study exploring the mechanisms of reduced tactile function
Numbness in clinical and experimental pain - A cross-sectional study exploring the mechanisms of reduced tactile function
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DOI：
10.1016/j.pain.2008.03.006
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发表时间：
2008-09-30
期刊：
影响因子：
7.4
通讯作者：
Birklein, Frank
中科院分区：
文献类型：
--
作者：
Geber, Christian;Magerl, Walter;Birklein, Frank
疼痛患者经常报告疼痛皮肤的明显麻木，尽管没有明显的结构性外周或中枢神经损伤。在这项横断面研究中，我们评估了触觉功能的减少，并研究了慢性疼痛患者和健康参与者暴露于阶段性和强直性实验伤害性刺激的潜在机制。对10例单侧肌肉骨骼疼痛患者进行疼痛区和非疼痛对侧的机械检测（MDT）和疼痛阈值（MPT）评估。此外，10名健康参与者暴露于施加于掌侧前臂的伤害性刺激（辣椒素，电刺激，各两次）。评估触觉感觉减退和机械痛觉过敏的区域。在刺激部位附近定量MDT和MPT。疼痛患者和实验性疼痛中的触觉减退（MDT-z-评分分别为：-0.66 +/- 0.30和-0.42 +/- 0.15，均p < 0.01）被机械痛觉过敏（MPT-z-评分：+0.51 +/- 0.27，p < 0.05;和+0.48 +/- 0.10，p < 0.001）消除。然而，感觉减退和痛觉过敏不相关。尽管9名患者报告麻木，但其中只有3名能够描绘触觉感觉减退的界限区域。在实验性疼痛中，31/40（780%）的实验可以映射触觉减退的区域。无论伤害性刺激的模式（阶段性与强直性）触觉感觉减退和痛觉过敏的发展具有相似的时间过程，并在约1天内消失。在临床疼痛中经常遇到的感觉减退（麻木）可以通过实验性伤害性刺激再现。影响的时间过程表明涉及中央可塑性的机制。(C)2008年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
Pain patients often report distinct numbness of the painful skin although no structural peripheral or central nerve lesion is obvious. In this cross-sectional Study we assessed the reduction of tactile function and studied underlying mechanisms in patients with chronic pain and in healthy participants exposed to phasic and tonic experimental nociceptive stimulation. Mechanical detection (MDT) and pain thresholds (MPT) were assessed in the painful area and the non-painful contralateral side in 10 patients with unilateral musculoskeletal pain. Additionally, 10 healthy participants were exposed to nociceptive stimulation applied to the volar forearms (capsaicin, electrical stimulation, twice each). Areas of tactile hypaesthesia and mechanical hyperalgesia were assessed. MDT and MPT were quantified adjacent to the stimulation site. Tactile hypaesthesia in pain patients and in experimental pain (MDT-z-scores: -0.66 +/- 0.30 and -0.42 +/- 0.15, respectively, both p < 0.01) was paralleled by mechanical hyperalgesia (MPT-z-scores: + 0.51 +/- 0.27, p < 0.05; and +0.48 +/- 0.10, p < 0.001). However, hypaesthesia and hyperalgesia were not correlated. Although 9 patients reported numbness, only 3 of them were able to delineate circumscript areas of tactile hypaesthesia. In experimental pain, the area of tactile hypaesthesia could be mapped in 31/40 experiments (780%). Irrespective of the mode of nociceptive stimulation (phasic vs. tonic) tactile hypaesthesia and hyperalgesia developed with a similar time course and disappeared within approximately I day. Hypaesthesia (numbness) often encountered in clinical pain can be reproduced by experimental nociceptive stimulation. The time course of effects suggests a mechanism involving central plasticity. (C) 2008 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.