定量感觉测试在德国神经病理性疼痛研究网络（DFNS）中的应用：1236 例不同神经病理性疼痛综合征患者的躯体感觉异常。
Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes.
机构信息
Department of Pain Management, BG Universitätsklinikum Bergmannsheil GmbH, Ruhr University, Bochum, Germany Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany Department of Neurology, Technische Universität, München, Germany Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim, Ruprecht-Karls-University, Heidelberg, Germany Department of Neurology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany Institute of Physiology and Experimental Pathophysiology, University of Erlangen, Germany Department of Cognitive and Clinical Neuroscience, Central Institute for Mental Health, Ruprecht-Karls-University, Heidelberg, Germany Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Germany Department of Neurology, University of Würzburg, Germany Department of Neurology, University of Ulm, Germany Department of Neurosurgery, University Campus Lübeck, Germany.
出版信息
Pain. 2010 Sep;150(3):439-450. doi: 10.1016/j.pain.2010.05.002.
Neuropathic pain is accompanied by both positive and negative sensory signs. To explore the spectrum of sensory abnormalities, 1236 patients with a clinical diagnosis of neuropathic pain were assessed by quantitative sensory testing (QST) following the protocol of DFNS (German Research Network on Neuropathic Pain), using both thermal and mechanical nociceptive as well as non-nociceptive stimuli. Data distributions showed a systematic shift to hyperalgesia for nociceptive, and to hypoesthesia for non-nociceptive parameters. Across all parameters, 92% of the patients presented at least one abnormality. Thermosensory or mechanical hypoesthesia (up to 41%) was more frequent than hypoalgesia (up to 18% for mechanical stimuli). Mechanical hyperalgesias occurred more often (blunt pressure: 36%, pinprick: 29%) than thermal hyperalgesias (cold: 19%, heat: 24%), dynamic mechanical allodynia (20%), paradoxical heat sensations (18%) or enhanced wind-up (13%). Hyperesthesia was less than 5%. Every single sensory abnormality occurred in each neurological syndrome, but with different frequencies: thermal and mechanical hyperalgesias were most frequent in complex regional pain syndrome and peripheral nerve injury, allodynia in postherpetic neuralgia. In postherpetic neuralgia and in central pain, subgroups showed either mechanical hyperalgesia or mechanical hypoalgesia. The most frequent combinations of gain and loss were mixed thermal/mechanical loss without hyperalgesia (central pain and polyneuropathy), mixed loss with mechanical hyperalgesia in peripheral neuropathies, mechanical hyperalgesia without any loss in trigeminal neuralgia. Thus, somatosensory profiles with different combinations of loss and gain are shared across the major neuropathic pain syndromes. The characterization of underlying mechanisms will be needed to make a mechanism-based classification feasible.
神经性疼痛伴有阳性和阴性感觉体征。为了探索感觉异常的范围，根据德国神经病学研究网络（DFNS）的方案，通过定量感觉测试（QST）对 1236 名临床诊断为神经性疼痛的患者进行了评估，使用热和机械伤害性以及非伤害性刺激。数据分布显示，伤害性参数出现痛觉过敏，非伤害性参数出现感觉迟钝的系统性偏移。所有参数中，92%的患者至少存在一种异常。热敏或机械感觉迟钝（高达 41%）比痛觉减退（高达 18%的机械刺激）更为常见。机械性痛觉过敏比热痛觉过敏更为常见（钝压：36%，刺痛：29%），而热痛觉过敏（冷觉：19%，热觉：24%）、动态机械性触诱发痛（20%）、矛盾性热感觉（18%）或增强的 wind-up（13%）则较少见。感觉过敏小于 5%。每种感觉异常都发生在每一种神经综合征中，但频率不同：复杂区域疼痛综合征和周围神经损伤中最常见的是热和机械性痛觉过敏，带状疱疹后神经痛中最常见的是触诱发痛。在带状疱疹后神经痛和中枢性疼痛中，亚组表现为机械性痛觉过敏或机械性感觉迟钝。增益和损失的最常见组合是无痛觉过敏的混合性热/机械性损失（中枢性疼痛和多发性神经病）、周围神经病中的混合性损失伴机械性痛觉过敏、三叉神经痛中的无任何损失的机械性痛觉过敏。因此，不同组合的损失和增益的躯体感觉谱在主要的神经性疼痛综合征中是共享的。为了使基于机制的分类成为可能，需要对潜在机制进行特征描述。
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