Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin

被引：29

作者：

Mainka, Tina ^{[1
]}

Bischoff, Florian S. ^{[1
]}

Baron, Ralf ^{[2
]}

Krumova, Elena K. ^{[3
]}

Nicolas, Volkmar ^{[4
]}

Pennekamp, Werner ^{[4
]}

Treede, Rolf-Detlef ^{[5
]}

Vollert, Jan ^{[1
]}

Westermann, Andrea ^{[1
]}

Maier, Christoph ^{[1
]}

机构：

[1] Ruhr Univ Bochum, Berufsgenossenschaftl Univ Klinikum Bergmannsheil, Dept Pain Med, D-44789 Bochum, Germany

[2] Univ Klinikum Schleswig Holstein, Sekt Neurol Schmerzforsch & Therapie, Neurol Klin, D-24105 Kiel, Germany

[3] Ruhr Univ Bochum, Berufsgenossenschaftl Univ Klinikum Bergmannsheil, Dept Neurol, D-44789 Bochum, Germany

[4] Ruhr Univ Bochum, Berufsgenossenschaftl Univ Klinikum Bergmannsheil, Inst Diagnost Radiol Intervent Radiol & Nucl Med, D-44789 Bochum, Germany

[5] Heidelberg Univ, Ctr Biomed & Med Technol Mannheim, D-68167 Mannheim, Germany

来源：

PAIN | 2014年 / 155卷 / 03期

关键词：

Complex regional pain syndrome (CRPS); Inflammation; Pressure-pain threshold; Quantitative sensory testing; Three-phase bone scintigraphy; REFLEX SYMPATHETIC DYSTROPHY; 3-PHASE BONE-SCINTIGRAPHY; SYNDROME TYPE-1; DIAGNOSIS; INFLAMMATION; METAANALYSIS; INNERVATION; DEEP; HYPERALGESIA; PATTERNS;

D O I：

10.1016/j.pain.2013.12.014

中图分类号：

R614 [麻醉学];

学科分类号：

100217 [麻醉学];

摘要：

Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPTThenar: 243 +/- 150 kPa vs 358 +/- 197 kPa, PPTMCP: 80 +/- 67 kPa vs 159 +/- 93 kPa, PPTPIP: 80 +/- 56 kPa vs 184 +/- 110 kPa; P <.01) and controls (PPTThenar: 478 +/- 106 kPa, PPTMCP: 254 +/- 50 kPa, PPTPIP: 275 +/- 76 kPa; P <.01). A PPTThenar below 293 kPa revealed 77% sensitivity but only 63% specificity, whereas a PPTPIP below 102 kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPTMCP and PPTPIP correlated significantly inversely with the ROI ratio (MCP: r = -0.439, PIP: r = -0.447). PPTPIP shows higher specificity for CRPS type I than PPTThenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology. (C) 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

引用

页码：591 / 597

页数：7

共 42 条

[1]

Thermal hypoaesthesia differentiates secondary restless legs syndrome associated with small fibre neuropathy from primary restless legs syndrome [J].