止血带
医学
麻醉
骨关节炎
可视模拟标度
有害刺激
痛觉减退
伤害
定量感官测试
大腿
体感系统
感觉阈
痛阈
外科
感觉系统
心理学
痛觉过敏
内科学
替代医学
受体
病理
认知心理学
认知科学
精神科
出处
期刊:Pain
[Ovid Technologies (Wolters Kluwer)]
日期:2000-10-01
卷期号:88 (1): 69-78
被引量:459
标识
DOI:10.1016/s0304-3959(00)00310-9
摘要
To investigate the influence of chronic nociceptive pain on endogenous pain modulation, the effect of heterotopic noxious conditioning stimulation (HNCS) on perception of various somatosensory modalities was assessed in 15 patients with painful osteoarthritis of the hip. Thirteen patients were re-assessed when pain-free 6–14 months following surgery. Sex- and age matched healthy subjects assessed at similar time intervals served as controls. The effects of HNCS were tested using the upper extremity submaximal effort tourniquet test. Subjects rated tourniquet-induced pain intensity on a visual analogue scale (VAS). Quantitative sensory testing (QST) was performed contralaterally to the maximally painful area in 13 patients and contralaterally to the second most painful area in two patients (i.e. lateral thigh n=12, frontal thigh n=1, lateral calf n=2). Sensibility was assessed before, during and 45 min following the tourniquet test. Perception thresholds to light touch were assessed using von Frey filaments and pressure pain thresholds by pressure algometry. Perception thresholds to non-painful and painful warmth and cold were determined using a Thermotest. In both sessions, patients rated the tourniquet-induced pain higher than controls at the start (P<0.003 and P<0.006, respectively), but not at the end of the tourniquet test. Decreased sensitivity to light touch (P<0.001) and innocuous cold (P<0.002) was seen during the tourniquet in patients and controls alike, on both occasions, while perception thresholds to innocuous warmth and heat pain remained unaffected. In the first session, pressure pain thresholds increased during the tourniquet test in controls (P<0.002), but not in patients. In the second session, pressure pain thresholds increased during the tourniquet test in controls (P<0.001) and in patients (P<0.02). In conclusion, no pressure pain modulation was induced by HNCS in patients before surgery, as opposed to controls, suggesting a dysfunction in systems subserving ‘diffuse noxious inhibitory controls’ (DNIC). Normal pressure pain modulation induced by HNCS was seen when patients were re-assessed in a pain-free state following surgery, indicating that the dysfunction of DNIC had been maintained by chronic nociceptive pain.
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