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

坐骨神经痛是一个用来描述影响臀部、臀部和腿部的疼痛症状的术语。它是由背部下部受伤或刺激的神经引起的。坐骨神经痛本质上可以感觉到灼热、尖锐或电击。坐骨神经痛也会导致虚弱和针刺痛。坐骨神经痛是一种复杂的疾病，不同的患者可能由不同的机制引起疼痛。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，可能会对日常生活产生毁灭性的影响。例如，一些患者失去了独立性，在穿衣等日常任务中需要帮助。可悲的是，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。我们目前尚不清楚为什么有些患者会出现持续性坐骨神经痛，为什么有些患者会康复。先前的研究已经证明，通常的临床表现(例如，抑郁症的存在或标准MRI扫描中的变化)不能预测持续性坐骨神经痛。因此，需要一种不同的方法来识别可能发展为持续性坐骨神经痛的患者。这是预测研究的目标。之前的研究只包括一次简短的临床检查。我们的研究是不同的。我们将执行一组详细的测试(见下文)。我们的抱负是，详细的测试可以预测谁会患上持续性坐骨神经痛。我们计划在Forecast研究中回答的问题是：1.详细测试能否识别出导致坐骨神经痛的相似机制的患者？2.这些详细测试中哪些可以预测持续性坐骨神经痛？Forecast研究是由牛津大学的一个由医生、神经学家、统计学家和磁共振成像(MRI)专家组成的团队进行的。该团队还包括患者的合作伙伴。他们帮助我们确保我们的研究对患者有用。我们将邀请180名最近出现坐骨神经痛疼痛(&lt；3个月)的患者参与预测研究。在他们的初步评估中，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感受不同刺激的程度，如寒冷、温暖或压力。这告诉我们神经工作得有多好，它变得有多敏感。我们还将包括一套精确的问卷，以评估疼痛的类型(例如，灼伤、电击或疼痛)和情绪健康。当患者有坐骨神经痛时，情绪健康会受到影响。例如，一些患者可能会感到焦虑或愤怒，另一些患者可能会感到孤独，与朋友和家人疏远。我们还将采集血液样本，以寻找炎症的迹象。在一些患者中，我们将使用专门的核磁共振扫描。这些图像比标准的核磁共振扫描更详细、更专业。它们使我们能够评估背部微小神经的微观结构，这是标准的MRI扫描所不可能做到的。这些详细的测试将为我们提供一个很好的画面，了解患者的坐骨神经痛经历的起点。然后，我们将在三个月和一年后再次联系患者，询问他们是否仍然存在坐骨神经痛。我们将使用统计数据来识别具有类似机制的患者，这些患者会导致坐骨神经痛。我们还将检查哪些测试可以预测持续性坐骨神经痛。预测性研究的结果将有助于我们更好地了解坐骨神经痛的复杂性以及谁会出现持续性疼痛。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预测研究显示可能出现持续性坐骨神经痛的患者进行更具体的治疗来预防或减少持续性疼痛。我们希望预测性研究的结果将有助于减少坐骨神经痛患者的痛苦，提高患者的生活质量。

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.