Pain threshold, anxiety and other factors affect intensity of postoperative pain in gastric cancer patients: A prospective cohort study

Objective: This prospective cohort study explored factors related to postoperative pain in gastric cancer patients.Methods: A total of 236 patients who underwent gastrectomy were enrolled. All patients enrolled in the study completed the Hospital Anxiety and Depression Scale(HADS) questionnaire and Life Orientation Test-Revised(LOT-R) questionnaire on the day before surgery. Heat pain threshold(HPT), cold pain threshold(CPT) and pressure pain threshold(PPT) were measured for all patients one day prior to surgery and demographic details were collected. All patients were connected to a patient-controlled intravenous analgesia(PCIA) pump at the end of the surgery. The occurrence of postoperative pain was used as a dependent variable, and multivariate logistic regression analyses were conducted to screen for factors affecting postoperative pain.Results: In total, 83 patients(35.2%) had postoperative pain. Body mass index(BMI) ≥28 kg/m^(2) [odds ratio(OR): 2.67;95% confidence interval(95% CI): 1.07-6.67], total gastrectomy(OR: 2.64;95% CI: 1.42-4.91),preoperative anxiety score ≥8(OR: 2.37;95% CI: 1.12-5.02), heat pain threshold ≤4.9 s(OR: 2.14;95% CI:1.06-4.32), pressure pain threshold ≤4 g(OR: 2.05;95% CI: 1.05-4.03), and female gender(OR: 1.99;95% CI:1.04-3.83) were risk factors for postoperative pain.Conclusions: Obesity, wide range of gastrectomy, high preoperative anxiety, low HPT and PPT, and female gender are associated with increased risk for postoperative pain.

Effects of Electroacupuncture on the Pain Threshold and the NMDA R1 mRNA in DRG on Neuropathic Pain Rats

To observe the effect of multiple electroacupuncture (EA) on the pain threshold and the regulation of N-methyl-D-aspartate (NMDA) receptor in dorsal root ganglia (DRG) of neuropathic pain rats. Rats were prepared with a unilateral chronic constriction injury (CCI) to the sciatic nerve. EA was done in acupoints 'Huan Tiao' and 'Yang Ling Quan' for 30 min every day and the thermal thresholds were detected after EA at 3, 5, 7, 10, 14 days after operation. On day 14 after nerve injury, the in situ hybridization method was used to investigate the change of NMDA R1 mRNA in L4-L5 DRG. The thermal threshold reduced significantly from day 3 after operation in CCI rats. After multiple EA treatment, the ipsilateral thermal hyperalgesia relieved gradually and the thermal threshold had no difference with control side after day 5(P>0. 05). From Day 7 after operation, the thermal threshold at each time point were significantly different compared with CCI group respective-ly(P>0. 05). Moreover the EA had accumulative effect. On Day 14 after operation , the NMDAR1 mRNA positive neurons and the mean optic density in ipsilateral L4-5 DRG were less than that of control side(P<0. 05), mainly in medium and small neurons. After EA treatment, the NMDARl mRNA positive neurons in ipsilateral DRG had no considerable difference comparing with those of control side , significantly increased comparing with CCI group(P<0. 05). It's concluded that the NMDA receptors in DRG relate closely with the generation and development of neuropathic pain. The multiple EA treatment can attenuate the thermal hyperlgesia of neuropathic pain rats and regulate the NMDA receptor.

The Differing Effects of Nociception and Pain Memory on Pain Thresholds in Participants with and without a History of Injury: A Pretest-Posttest Quasi Experimental Study

Purpose: Memory has been identified as an important protective feature to prevent future injury, but its role has yet to be ascertained. The current study aimed to determine whether there was a difference in pressure pain threshold (PPT) responses between participants with a prior history of injury of lower extremity injury (PSI) and those without (NPSI) when exposed to 1) experimental mechanical pain, 2) short-term memory recall of a painful stimulus, or 3) long-term memory of the pain associated with a prior injury. Subjects and Methods: The study used a pretest-posttest quasi-experimental design. A convenience sample of 59 pain-free participants was recruited from an urban university. Twenty-nine PSI and 30 NPSI were stratified into two groups based on their injury history with PPT values measured at baseline and immediately following each of the three experimental conditions. A repeated measure ANCOVA analysis was conducted for each condition to determine whether there was a difference in PPT responses between the two groups. Results: There was a statistically significant difference in PPT values between the two groups when exposed to experimental pain, F(1,57) = 6.010, p = 0.017, partial η2 = 0.095 and with long-term pain memory, F(1,57) = 4.886, p = 0.031, partial η2 = 0.079. There was no statistically significant difference between groups with short-term pain memory, F(1,57) = 3.925, p = 0.052, partial η2 = 0.064. Conclusions: These findings suggest that pain processing may be altered by pain memory, highlighting the role of experience and memory in the rehabilitation process.

Effects of Electroacupuncture on Pain Threshold and Prostaglandin E2 in Spinal Cord in Postoperative Pain Rat

Objective:Electroacupuncture(EA)is good at post-surgical pain.But point selection method in treating incision-induced pain remains a major clinical challenge.We reasoned that different acupoints may work though adjusting prostaglandin E2 in spinal cord.We wish to explore the analgesic mechanism of electroacupuncture on plantar incision pain rats and provide more therapeutic ideas for acupuncture analgesia.Methods:A total of 50 male rats were randomly divided into a sham operation group,a model group,an EA 1,EA 2 and a drug group(n=10,each).A rat model of left plantar incision pain was established.The rats in EA1 group was needled at ipsilateral Yanglingquan(GB34)and Taixi(KI3).The rats in EA2 group was needled at ipsilateral Quchi(LI11)and Hegu(LI4).EA stimulation(2/100 Hz,1-2-3 mA)was administered 30 minutes immediately after operation.The rats in drug group were fed with Fenbid by gavage 20 minutes before incision(30 mg/kg,p.o.).The hot plate pain detector was used to measure the thermal pain threshold(TPT)before and 24 hours after operation Prostaglandin E2 content of spinal cord was detected by enzyme-linked immunosorbent assay(ELISA)at 1 and 24 hours after operation.Results:Compared with sham operation group,the TPT in model group decreased 41%.Compared with the model group,the TPT increased 56%in EA1,29%in EA2,190%in drug group(P>0.05).At 1 h after operation,compared with the sham operation group,PGE_2 in model group increased 15%.Compared with the model group,PGE_2 in drug group decreased 5%.At 24 hours after operation,compared with sham operation group,PGE_2 in model group increased 9%.Compared with model group,it decreased 4%in EA 1 group,8%in drug group and increased 3%in EA2 group.Conclusion:Both the drug and the electroacupuncture can adjust the 24-hour pain threshold and PGE_2 in spinal cord.The curative effects of the drug are better than that of electroacupuncture.The proximal point is better than that of the distal point.Electroacupuncture can treat postoperative pain by regulating PGE_2 in spinal cord.

Electrical Activities and Pressure Pain Threshold in Oral Contraceptives Users and Nonusers

The aim is to evaluate the influence of oral contraceptive intake and menstrual cycle on the electrical activity and pressure pain threshold from anterior temporal and masseter muscles. Twenty-eight women on reproductive age were selected, 13 OC users and 15 nonusers. They were weekly submitted to electromyography and algometry of the anterior temporal and masseter muscles during three consecutive menstrual cycles. Electrical activities at rest position and PPTs of temporal and masseter muscles were not affected by menstrual cycle or by OCs uses. Comparison between groups demonstrated that working side electrical activity was increased in OC users in both muscles, except during lutheal phase for the anterior temporal. However, comparison within weeks did not demonstrate statistical difference. It was suggested that, in healthy women, oral contraceptive use may influence electrical activity, but different phases of the cycle may not.

Effects of morphine and electroacupuncture on substance P level in spinal cord and their relation to pain threshold in rats

Immunoreactive substance P(Ir-SP)level,and substance P likeimmunoreactivity(SP-Li)in the spinal cord were observed with radioimmunoassay andimmunohistochemistry in rats after they were given an intraperitoneal injection of mor-phine(7.5mg/kg)or electroacupunctured(3V and 3Hz)on the “Jiaji point”.It wasfound that the pain threshold(PT),Ir-SP level and SP-Li in the dorsal horn of the spi-nal cord were more significantly increased in the animals after the administration ofmorphine or electroacupuncture than in the control(P【0.05～0.01).The combined effectsof morphine and electropacupuncture were even more powerful than either of the agentswas administered singly.Naloxone could block the analgesic effect and the elevation ofIr-SP due to morphine or electroacupuncture.The findings suggest that there is a synergismbe tween morphine and electroacupuncture and the analgesic effect of the 2 depends uponthe increase of Ir-SP level of the spinal cord mediated through the opiate receptors.

Lumbar interspinous pressure pain threshold values for healthy young men and women and the effect of prolonged fully flexed lumbar sitting posture:An observational study

BACKGROUND Low back pain(LBP)is a common condition with large burden worldwide.Exposure to prolonged sitting with a flexed lumbar posture has been suggested in the literature to be a potential risk factor for self-reported LBP.No study has previously investigated whether exposure to prolonged flexed sitting posture provokes discomfort/pain and decreased interspinous pressure pain thresholds for healthy young men and women without back pain,despite this being a suggested risk factor for LBP.AIM To investigate whether sitting in a prolonged flexed lumbar posture provokes discomfort and lowers interspinous pressure pain thresholds in the lumbar spine for healthy young men and women without previous LBP.METHODS This is a an observational before and after study of 26 participants(13 men,13 women)between 20-35 years old.Algometry was used to examine the pain threshold for pressure applied between spinous processes of the lumbar spine L1-L5.Pressure algometer measures were performed in prone before and after participants were instructed to sit in a fully flexed posture for a maximum of 15 min or until discomfort was experienced in the low back(Borg CR10=7/10).Wilcoxon signed-rank test was used for analyze values from the before and after test conditions.Mann-Whitney U test was used to investigate potential gender difference.RESULTS Fully flexed lumbar spine sitting posture up to 15 min provoked temporary discomfort but the proportion of participants experiencing discomfort 7/10 in the low back was 62%.For all pain pressure threshold locations tested,there was a significant difference for the study population with moderate-large decreased(r=-0.56)pressure pain threshold after exposure to prolonged flexed sitting posture(P<0.01).Comparisons between gender did not show any significant difference.CONCLUSION The result showed that exposure to fully flexed lumbar sitting posture for up to 15 min produced temporary discomfort in the low back in young healthy adults with no previous history of LBP and significantly reduced lumbar interspinous pressure pain thresholds.No gender-based differences were observed.

Effect of Intracerebral Injection of Substance P on Pain Threshold,Electroacupuncture Analgesia and Met-enkephalin Level in Rat Brain

Radioimmunoassay was employed to dctermine the immunorcactivc met-enkephalin(ir-MEK)contents of several brain regions .The pain threshold(PT)andir-MEK content of striatum and hypothalamus increased markedly afterintraoerebroventricular injection of substance P(SP)in the dosage of lμgg/10μl ,but nosignificant change of ir-MEK content in hippocampus was observed.When theperiaqueductal gray(PAG)was destroyed with electrolysis,the increase of PT andir-MEK content in the two brain regions after SP injection was obviouslysuppressed(P【0.05-0.01).The PT and ir-MEK content of hypothalamus andstriatum would also increase after intra-PAG injection of SP(0.4μg/4μl),electroacupuncture or intraperitoneal injection of morphine.The ir-MEK content ofhippocampus could also increase after intra-PAG injection of SP or intraperitoncal injec-tion of morphine.The combination of intra-PAG injection of SP andelectroacupuncture caused a more marked elevation of PT and ir-MEK content of the 3brain regions than either of the two used singly could(P【0.01 ).The combined effect ofintra-PAG injection of SP and intraperitoneal injection of morphine was similar to thatof either of the two used singly(P】0.05).These facts indicate that thc analgesic effect ofSP activated by PAG was mediated through the increase of cerebral met-cnkcphalin con-tent,and there was a synergic effect between SP and elcctroacupuncturc.

Changes in sternocleidomastoid and descending portion of trapezius muscles in terms of electromyography and pressure pain threshold: women with chronic neck pain after acupuncture treatment

OBJECTIVE:To evaluate the sternocleidomastoid and the descending portion of the trapezius muscles in terms of electromyographic activity and pressure pain threshold in women with chronic cervical pain after acupuncture treatment.METHODS:Twenty-five women,aged 18-50 years[(31±3)years],with chronic neck and temporomandibular disorder participated in the study.The electromyographic activity of the sternocleidomastoid muscle and the descending portion of the trapezius muscle were recorded at rest,during shoulder elevation,(left and right)rotation of the neck and crucifix position.Maximum voluntary contraction was used to normalize the electromyographic activity data.The points used for acupuncture were Jiache(ST 6),Xiaguan(ST 7),Quanliao(SI 18),Tinggong(SI 19),Yifeng(TE-17),Fengchi(GB 20),Renzhong(GV 26),Yangbai(GB-14),and points of the lower and upper limbs:Tai chong(LV 3),Zusanli(ST 36),Sanyinjiao(SP 6),Kunlun(BL 60),He Gu(LI4)and Yanglingquan(GB 34).The treatment course was 10 sessions,30 min long per session,and twice a week.The final electromyographic activity and pressure pain threshold data collection were performed 15 d after treatment completion.RESULTS:The normalized electromyographic activity and pressure pain threshold data were tabulated and submitted to statistical analysis using t-test(P<0.05).Significant difference was observed during shoulder elevation for the left trapezius muscle,during neck rotation from the right side to the left,and pressure pain threshold for the trapezius and sternocleidomastoid muscles,bilaterally,after the acupuncture treatment.CONCLUSION:The acupuncture treatment improved the neck muscles in terms of electromyographic activity and increased the tolerance to chronic pain in women.

Study of the thermal pain threshold latency of acupoints based on Fei Teng Ba Fa

Objective： By applying moxibustion to the eight confluent points in different periods of time, to observe the changes in thermal pain threshold latency of acupoints based on Fei Teng Ba Fa. Methods： A total of 468 healthy college student volunteers received moxibustion at the eight confluent points in three different periods of time, i.e. Chen （7：00-9：00）, Wu （11：00-13：00） and Xu （19：00-21：00）. The thermal pain threshold latency was adopted to measure the changes in pain threshold of the eight confluent points under different conditions （different periods of time, different genders, different acupoints and different states of the acupoints） based on Fei Teng Ba Fa. Results： Finally, thirty subjects dropped out and 438 subjects were included. The comparison of thermal pain threshold latencies of the eight confluent points in the same opening or closing state based on Fei Teng Ba Fa： latencies of the closing points and adjunct points were significantly different in different periods of time （P〈0.05）, the latencies of the males were significantly longer than those of the females （P〈0.05）; there was no significant difference in the latency between the left and right sides （P〉0.05）; in the female group, there was a significant difference in the latency between the lower-limb points and the upper-limb points （P〈0.05）. The comparison of thermal point threshold latencies of the eight confluent points in different opening or closing state： in the period of Wu （11：00-13：00）, the latencies of the opening points were significantly longer than those of the closing points and adjunct points （P〈0.05）; for men, their opening and closing points had significantly longer thermal pain threshold latencies than their adjunct points （P〈0.05）; despite the gender, the latencies of the upper limb opening and closing points were significantly longer than the latency of the adjunct points （P〈0.05）; in the female group, the latencies of the lower-limb opening points were significantly shorter than those of the lower-limb closing and adjunct points （P〈0.05）. Conclusion： Based on Fei Teng Ba Fa, the pain thresholds of the eight confluent points vary in different periods of time, gender, acupoint location and opening/closing state, which can be taken as the evidence of making time-based acu puncture-moxibustion prescriptions.

Role of transient receptor potential vanilloid subetype 1 in the increase of thermal pain threshold by moxibustion

OBTECTIVE:To explore the role of transient receptor potential vaniiloid subetype 1(TRPV1) in the increase of the thermal pain threshold by moxibustion.METHODS:Forty Kunming mice(20 ± 2) g were randomized into control group,capsaicin group,capsazepine group,moxibustion group and moxibustion + capsazepine(MC) group with 8 mice in each,and 16 C57BL/6 wild-type mice(18 ± 2) g were randomized into wild-type(WT) control group and WT moxibustion group with 8 mice in each,and 14 TRPV1 knockout mice(18 ± 2) g were randomized into knockout(KO) control group and KO moxibustion group with 7 in each.Each mouse in the capsaicin group was subcutaneously injected with the amount of 0.1 mL/10 g into L5 and L6 spinal cords;each mouse in the capsazepine group was intraperitoneally injected with the amount of0.1 mL/10 g.Similarly,each mouse in the moxibustion group was given a suspended moxibustion with specially-made moxa-stick for 20 min on L5 and L6 spinal cords.Each mouse in MC group was intraperitoneally injected with the amount of 0.1 mL/10 g first,then after 15 min was given a suspended moxibustion for 20 min on L5 and L6 spinal cords.Each mouse in WT moxibustion group and KO moxibustion group was given a suspended moxibustion with specially-made moxa-stick for 20 min on L5 and L6 spinal cords.The control group,WT control group and KO control group were of no treatment in any way.After all treatments were completed,the digital-display measurement instrument for thermal pain was used to measure the threshold of thermal pain in each group respectively.RESULTS:Compared with the control group,the thresholds of thermal pain in the moxibustion group and MC group were significantly increased(P <0.01);no significant changes in the thresholds in the capsaicin group and the capsazepine group(P > 0.05);compared with moxibustion group,he threshold of thermal in MC group was obviously decreased(P < 0.01).Compared with WT control group,the threshold of thermal pain in WT moxibustion group was significantly increased(P <0.01);compared with KO control group,no changes in the threshold in KO moxibustion group(P > 0.05).CONCLUSION:TRPV1 participated in the process of increasing the threshold of thermal pain by stimulating L5 and L6 of mice spinal cord with burning mosa-stick.

Effects of acupoints TENS on heat pain threshold in normal subjects

Objective To delineate the influence of transcutaneous electrical nerve stimulation (TENS) on heat pain threshold and vibration threshold in human. Methods Twenty healthy, young subjects, aged from 20 to 39, participated in the study. They were randomly allocated into either TENS or placebo group. Thirty minutes of conventional TENS (200 μs pulses at 100 Hz and 2-3 times sensory threshold) or placebo stimulation was applied to the acupuncture points (LI4) on each subject’s left hand. Heat pain and vibration thresholds were measured using Medoc TSA-2001 and VSA-3000 respectively on the thenar eminence of each subject’s left hand. These assessments were done at 30, 20 and 10 minutes before and 0, 10, 20, 30, 40 and 50 minutes after 30 minutes of TENS or placebo treatment. Results This study showed a significant increase in heat pain threshold by 0.81℃ and 1.54℃ respectively at 0 (P=0.002) and 20 minutes (P=0.004) after 30 minutes of TENS application to the LI4 acupoint of young healthy subjects, compared with placebo stimulation. Interestingly, no significant difference in vibration threshold was found between the TENS and placebo groups. Conclusion The effect of TENS on the acupoint is to reduce pain but not tactile (specifically vibration) sensibility.

腰椎间盘突出症模型大鼠疼痛的针刺干预

背景:针灸是缓解腰椎间盘突出症腰痛的有效方法,但其机制目前尚未明确。JAK2/STAT3信号通路相关因子可调节机体炎症反应,参与神经病理性疼痛的过程。目的:基于JAK2/STAT3信号通路研究针刺对腰椎间盘突出症模型大鼠的作用机制。方法:采用随机数字表法将40只SD大鼠分为假手术组、模型组、针刺组与针刺+激动剂组,每组10只。模型组、针刺组及针刺+激动剂组采用自体髓核移植法构建L5腰椎间盘突出症模型,造模3 d后,针刺组开始进行针刺治疗(作用于阳陵泉、肾俞、环跳、大肠俞等穴位),针刺+激动剂组造模后第6,12,18天针刺治疗前向L4/L5椎间隙鞘内注射JAK2激动剂香豆霉素A1,针刺治疗1次/d,20 min/次,连续治疗15 d。造模前及造模后3,6,9,12,15,18 d,检测大鼠机械缩足阈值;造模后18 d,检测血清炎症因子水平,苏木精-伊红染色观察L5-L6组织形态,RT-PCR检测L5-L6组织JAK2、STAT3 mRNA表达,Western Blot检测L5-L6组织JAK2、STAT3、p-JAK2及p-STAT3蛋白表达。结果与结论:①模型组大鼠造模后不同时间点的机械缩足阈值均低于假手术组(P<0.05),针刺组大鼠造模后9,12,15,18 d的机械缩足阈值均高于模型组(P<0.05),针刺+激动剂组大鼠造模后9,12,15,18 d的机械缩足阈值均低于针刺组(P<0.05);②与假手术组比较,模型组白细胞介素6、肿瘤坏死因子α、神经递质P物质、脑部神经肽Y水平均升高(P<0.05);与模型组比较,针刺组4种炎症因子水平均降低(P<0.05);与针刺组比较,针刺+激动剂组4种炎症因子水平均升高(P<0.05);③苏木精-伊红染色显示模型组大鼠腰椎退行性变化明显,针刺组与针刺+激动剂组大鼠腰椎退行性变化减轻,针刺组减轻更明显;④与假手术组比较,模型组JAK2与STAT3 mRNA表达、p-JAK2与p-STAT3蛋白表达均升高(P<0.05);与模型组比较,针刺组JAK2与STAT3 mRNA表达、p-JAK2与p-STAT3蛋白表达均降低(P<0.05);与针刺组比较,针刺+激动剂组JAK2与STAT3 mRNA表达、p-JAK2与p-STAT3蛋白表达均升高(P<0.05);⑤结果表明,针刺干预可通过降低腰椎间盘突出症模型大鼠的炎症反应来缓解疼痛,其作用机制可能与抑制JAK2/STAT3信号通路有关。

正常成人电刺激痛感觉阈与耐痛阈相关性及影响因素的多元线性回归分析

目的:测定正常成人在电刺激下的痛感觉阈(perception pain threshold,PTH)、耐痛阈(pain tolerance,PTO)水平,探讨影响因素,分析痛感觉阈、耐痛阈的关系,并建立正常成人的PTH、PTO参考值范围。方法:采用一元线性回归、多元线性回归分析等方法,回顾性分析2017年10月21日至2020年5月22日在陆军军医大学第一附属医院疼痛科使用体感诱发电位测量仪系统进行电刺激测试的正常成人痛阈相关数据,性别、年龄、职业、学历、婚姻、月收入、体质指数(body mass index,BMI)等一般资料。计算正常成人PTH、PTO参考值范围。结果:一元线性回归分析显示PTH与PTO的变化呈高度正相关(P<0.001)。分别以PTH、PTO的值为因变量,将性别、年龄、职业、学历、婚姻、月收入、BMI指数为自变量进行多元线性回归分析,结果表明性别是PTH、PTO的影响因素(P<0.001),不同性别PTH、PTO值有明显差异。男性、女性PTH、PTO的值均呈正态分布(P均<0.05),采用正态分布法计算男性PTH、PTO的95%参考范围分别为0.051~4.388、1.845~13.012,女性PTH、PTO的95%参考范围分别为0.146~3.069、1.521~10.207;男性PTH、PTO的平均值±标准差分别为2.219±1.224,7.429±8.115,女性PTH、PTO的平均值±标准差分别为1.608±0.556,5.864±4.910。结论:疼痛的敏感性女性高于男性,女性PTH、PTO正常值范围均较男性窄。疼痛的感受性与耐受性高度正相关。

PTI、IoC2和SPI在全身麻醉患者镇痛深度监测中的价值

目的探讨镇痛指数(PTI)、伤害敏感指数(IoC2)和手术容积指数(SPI)在全身麻醉患者镇痛深度监测中的价值。方法选取择期行腹腔镜胆囊切除术患者90例,采用区组随机法,按照不同镇痛深度监测指标分为IoC2组(A组)、SPI组(B组)和PTI组(C组),每组各30例。记录并比较各时间点患者心率(HR)、平均动脉压(MAP)、IoC2、SPI、PTI,测定并比较术前、术中和术后血清炎症因子(IL-6、IL-10)的水平。结果T2时IoC2、SPI和PTI与T1时比较(P<0.001);T3时SPI和PTI与T2时比较(P<0.05);T4时PTI和SPI与T3时比较(P<0.05);T4时IoC2与T2、T3时比较(P<0.001);T6时SPI和PTI与T5时比较(P<0.05);T7时IoC2、SPI、PTI与T5时比较(P<0.05);T8时IoC2、SPI和PTI与T7时比较(P<0.05)。各组内比较,IoC2、SPI和PTI具有时间变化趋势,且随着时间点不同均发生变化(P<0.001)。三组组间比较,HR、MAP、IoC2、SPI和PTI时间与组间存在交互效应,具有不相等的变化趋势(P<0.001)。IoC2、SPI、PTI与HR和MAP均呈正相关(P<0.05)。三组患者IL-6和IL-10术前、术中和术后比较,差异无统计学意义(P>0.05)。结论IoC2、PTI和SPI可作为全身麻醉术中疼痛监测的可靠指标,减轻术中应激反应,准确性优于HR、MAP。

颈项功治疗颈型颈椎病60例的疗效观察

目的:通过对颈型颈椎病患者进行锻炼干预,比较颈项功和常规米字操治疗颈型颈椎病的临床疗效及对颈痛、压痛阈(Pressure Pain Threshold,PPT)的影响。方法:选择2020年11―12月浙江中医药大学纳入的60例颈型颈椎病患者,应用随机数字表法将60例颈型颈椎病患者分为功法组和常规米字操组,每组各30例。功法组患者采用功法“仙鹤点水”锻炼,常规米字操组患者采用常规米字操锻炼,两组患者每天早晚各锻炼1次,以锻炼4周为一个疗程。锻炼前对两组患者进行压痛点筛查,结果得到两组患者压痛点多在肩井穴和C3夹脊穴,并以此作为PPT值的采集点。观察各组患者在锻炼前后的视觉模拟评分法(Visual Analogue Scale,VAS)评分、Northwick Park颈痛量表(Northwick Park Neck-pain Questionnaire,NPQ)评分及肩井穴和C3夹脊穴的PPT值,并综合评定各组的临床疗效。结果:锻炼4周后两组患者的VAS评分和NPQ评分均较锻炼前降低(P<0.05),两组患者肩井穴的PPT值均较锻炼前升高(P <0.05),功法组C3夹脊穴的PPT值较锻炼前升高(P <0.05),常规米字操组C3夹脊穴的PPT值与锻炼前差异无统计学意义(P> 0.05)。功法组的总有效率为86.67%(26/30),优于常规米字操组的63.33%(19/30)(P <0.05)。结论:功法和常规米字操均能改善颈型颈椎病患者的颈部疼痛和压痛,但功法的疗效更加显著。

腰椎融合术术前疼痛敏感性与术后疼痛程度和镇痛需求的关系

目的探讨腰椎融合术术前疼痛敏感性与术后疼痛程度和镇痛需求的关系。方法选择2022年1月至2023年6月在该院接受单节段腰椎融合术的67例患者作为研究对象,评估患者术前四个场景[肘静脉抽血、头孢类药物皮试、指尖血糖、测定腰椎活动范围(ROM)]时的视觉模拟疼痛评分(VAS)、热痛阈、机械痛阈、医院焦虑抑郁量表得分(HADS)、疼痛敏感性问卷得分(PSQ)、Oswestry功能障碍指数(ODI),采用Person相关性分析评估数据之间的相关性,采用二分类多因素Logistic回归分析术前疼痛敏感性与突破性镇痛之间的关系。结果Person相关性分析显示,性别与肘静脉抽血、头孢皮试、指尖血糖、测定腰椎ROM时的VAS评分呈正相关(P<0.05),与术前机械痛阈和热痛阈呈负相关(P<0.05)。年龄、BMI、术前诊断、融合节段等与术前VAS测试及痛阈均无显著相关性(P>0.05)。Person相关性分析显示,术前肘静脉抽血、药物皮试、指尖血糖、测定腰椎ROM时VAS评分与术后2~48 h的VAS评分均呈显著正相关(P<0.05)。术前热痛阈和机械痛阈与术后2~48 h的VAS评分呈显著负相关(P<0.05)。HAD-A、HAD-D和PSQ评分与术后2~48 h的VAS评分呈显著正相关(P<0.05)。二分类Logistic分析结果显示,术前机械痛阈是术后突破性镇痛的保护因素(P<0.05),HAD-S是术后突破性镇痛的风险因素(P<0.05)。结论术前患者疼痛敏化与术后疼痛相关,机械痛阈有助于预测腰椎融合术后突破性镇痛的发生。

非自杀性自伤患者的生理疼痛与社会疼痛及其影响因素研究进展

非自杀性自伤行为是目前临床中常见的病理行为,严重影响个体身心健康。自伤与个体疼痛感知异常密切相关。疼痛分为生理疼痛和社会疼痛,相比健康人群,非自杀性自伤患者对生理疼痛敏感性低而对社会疼痛敏感性高,生理疼痛阈值增高而社会疼痛阈值减低,疼痛敏感性的改变使其通过“以痛镇痛”的方式缓解情绪。非自杀性自伤个体疼痛敏感性的改变与社会心理因素密切相关,自我批评、抑郁症状和童年期不良经历都与非自杀性自伤患者的疼痛敏感性有关。

退行性颈椎病矢状位曲度参数与颈肩部肌肉痛阈的相关性

背景:退行性颈椎病患者一般存在颈椎曲度改变、颈肩部肌肉力量的不平衡及力量下降。目的:探讨退行性颈椎病矢状位曲度参数与颈肩部肌肉痛阈的相关性。方法:将2022年1月至2023年3月在上海交通大学医学院附属第九人民医院3D打印门诊中心收治的50例退行性颈椎病患者纳入研究,剔除颈椎X射线侧位片不符合测量条件的10例,拍摄颈椎侧位X射线片,测量Borden值、C_(2-7)Cobb角,并测量双侧上束斜方肌中点和C5-6棘突间旁1 cm处的疼痛阈值;分析退行性颈椎病矢状位曲度参数与颈肩部肌肉痛阈的相关性。结果与结论:①颈椎病矢状位曲度Borden值与左侧斜方肌上束痛阈、右侧斜方肌上束痛阈、C5-6棘突间旁左侧1 cm痛阈呈中等正相关关系(r=0.498,P<0.01;r=0.448,P<0.05;r=0.405,P<0.05),与C5-6棘突间旁右侧1 cm痛阈呈弱正相关关系(r=0.322,P<0.05);②C_(2-7)Cobb角与左侧斜方肌痛阈呈弱正相关关系(r=0.355,P<0.05),与右侧斜方肌痛阈、C5-6棘突间旁两侧1 cm痛阈不存在相关性;③颈肩部肌肉痛阈内部之间存在相关性,左右侧肌肉之间的痛阈及左右侧肌肉之内的痛阈皆存在高度相关性,提示颈肩部肌肉具有一致性,可能与颈肩部动作协同相关。

3D打印颈椎枕的压力疼痛评估及信度分析

目的:通过信度分析压痛测量仪评估颈肩部压痛的可靠性,并为3D打印个性化颈椎枕的临床效果评估提供新方式。方法:选取健康受试者36例,分别由2位评估者使用压痛测量仪对其颈肩部肌肉的7个测量点进行2次压痛阈测量,间隔7天后再次测量,采用Spearson相关系数计算评估者内和评估者间的信度,并使用Mann-Whitney U检验比较男性与女性的压痛阈值(pressure pain thresholds,PPT)。个性化颈椎枕使用前后,使用压痛测量仪对13例颈椎病患者选取具有代表性的4个测量点进行PPT测量,用以评估3D打印颈椎枕的治疗效果。结果:除了受测点C5、C6的棘突间旁1cm右侧和肩胛上角左侧外,各受测点评估者内信度均>0.65,各受测点评估者间信度均>0.75,可信度高;C5、C6的棘突间旁1cm右侧和肩胛上角左侧的评估者内组内相关系数(intraclass correlation coefficient,ICC)分别为0.65和0.56,中等信度(P<0.01);健康男性的斜方肌右侧、肩胛上角R、C5、C6的棘突间旁1cm左侧平均值要大于女性(P<0.05);斜方肌右侧、C5、C6的棘突间旁1cm右侧和C5、6的棘突间旁1cm左侧受测点3D打印颈椎枕治疗后的PPT平均值比治疗前大,差异具有显著性意义(P<0.05),说明疼痛有改善。结论:压痛测量仪评估正常健康人颈部压痛阈值信度较高,该方法稳定可靠,可作为3D打印颈椎枕临床效果评估的有效工具。