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膝骨关节炎患者的热痛觉过敏和机械性痛觉过敏

Thermal and mechanical pain sensitization in patients with osteoarthritis of the knee.

作者信息

Bevilaqua-Grossi Debora, Zanin Marilia, Benedetti Camila, Florencio Lidiane, Oliveira Anamaria

机构信息

a Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto-SP , Brazil.

出版信息

Physiother Theory Pract. 2019 Feb;35(2):139-147. doi: 10.1080/09593985.2018.1441930. Epub 2018 Feb 26.

Abstract

OBJECTIVE

The aim was to assess sensitization using quantitative sensory testing in mechanical and thermal modes in individuals with and without osteoarthritis (OA) of the knee. Pain thresholds were correlated with functionality, symptoms of depression and intensity of pain.

METHODS

Thirty control volunteers and 30 patients with OA of the knee were assessed. Punctate pain thresholds using Von Frey filaments and thermal pain thresholds using a Thermal Sensory Analyzer were evaluated in the periarticular region of the knee and forearm. Using a digital pressure algometer, pressure pain thresholds were assessed in the periarticular region of the knee and on the root exit zone on the lumbar and sacral spine.

RESULTS

Punctate, pressure, and thermal pain thresholds differed significantly between participants with and without OA (p < 0.05). Values in those with OA were consistent with pain sensitization. Pressure pain thresholds also showed moderate and negative correlations with data on functionality, symptoms of depression and intensity of pain (-0.36 < r > -0.56), contributing up to 30% of their variability.

CONCLUSIONS

Allodynia and hyperalgesia were demonstrated in the OA group, suggesting central sensitization in patients with mild to moderate severity of joint damage. Correlation between mechanical hypersensitivity and psychosocial factors seems to be small, despite of its significance.

摘要

目的

旨在通过定量感觉测试评估膝关节患骨关节炎(OA)和未患骨关节炎个体的机械性和热性感觉过敏情况。疼痛阈值与功能、抑郁症状及疼痛强度相关。

方法

对30名对照志愿者和30名膝关节OA患者进行评估。使用冯·弗雷细丝评估膝关节和前臂关节周围区域的点状疼痛阈值,使用热感觉分析仪评估热痛阈值。使用数字压力痛觉计评估膝关节关节周围区域以及腰骶部神经根出口区的压力痛阈值。

结果

患OA和未患OA的参与者之间,点状、压力和热痛阈值存在显著差异(p < 0.05)。OA患者的值与疼痛敏化一致。压力痛阈值与功能、抑郁症状及疼痛强度数据也呈中度负相关(-0.36 < r > -0.56),其变异性高达30%。

结论

OA组出现了痛觉异常和痛觉过敏,提示轻度至中度关节损伤患者存在中枢敏化。尽管机械性超敏反应与心理社会因素之间具有显著性,但二者之间的相关性似乎较小。

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