PDF(Pubmed)
Abstract：
To advance evidence-based practice and targeted treatments of low back pain (LBP), a better pathophysiological understanding and reliable outcome measures are required. The processing of nociceptive information from deeper somatic structures (e.g., muscle, fascia) might play an essential role in the pathophysiology of LBP. In this study, we measured the intra- and inter-session reliability of electrical detection and pain thresholds of cutaneous and muscle primary afferents of the lower back. Twenty healthy participants attended two study visits separated by 27.7 ± 1.7 days. To determine the location-specific electrical detection threshold (EDT) and pain threshold (EPT), needle electrodes were inserted in the epidermal layer over, and in the lumbar erector spinae muscle. Additionally, established quantitative sensory testing (QST) parameters were assessed. Reliability was determined by differences between measurements, intraclass correlation coefficients (ICC2,1), Bland-Altman plots, and standard error of measurement (SEM). Correspondence between QST parameters and electrical thresholds was assessed using Pearson\'s correlation. Except for cutaneous EPT, no significant (p ≤ 0.05) intra- and inter-session differences were observed. Excellent intra-session reliability was shown for cutaneous and intramuscular electrical stimulations and all QST parameters (ICC: 0.76-0.93). Inter-session reliabilities were good (ICC: 0.74-0.75) except for electrical stimulations (ICC: 0.08-0.36). Limits of agreement and SEM were higher for inter-session than intra-session. A medium to strong relationship was found between electrical and mechanical/pressure pain thresholds. In conclusion, cutaneous and intramuscular electrical stimulation will potentially close an important diagnostic gap regarding the selective examination of deep tissue afferents and provide location-specific information for the excitability of non-nociceptive and nociceptive afferents.
摘要：
为了推进下腰痛（LBP）的循证实践和靶向治疗，需要更好的病理生理学理解和可靠的结局指标.从更深的躯体结构中处理伤害性信息(例如，肌肉，筋膜）可能在LBP的病理生理中起重要作用。在这项研究中,我们测量了下背部皮肤和肌肉原发性传入的电检测和疼痛阈值的会内和间期可靠性.20名健康参与者参加了两次研究访问，间隔27.7±1.7天。要确定特定位置的电检测阈值（EDT）和疼痛阈值（EPT），针状电极插入表皮层上方,在腰椎竖脊肌。此外,对建立的定量感官测试(QST)参数进行了评估。可靠性由测量之间的差异决定，类内相关系数(ICC2,1)，Bland-Altman阴谋,和测量标准误差(SEM)。使用Pearson相关性评估QST参数与电阈值之间的对应关系。除了皮肤EPT,没有观察到显著(p≤0.05)的会议内和会议间差异。对于皮肤和肌肉电刺激以及所有QST参数（ICC：0.76-0.93），均显示出出色的会话内可靠性。除了电刺激（ICC：0.08-0.36）外，会议间可靠性良好（ICC：0.74-0.75）。会议间的协议和SEM限制高于会议间。在电和机械/压力疼痛阈值之间发现了中等到强的关系。总之,皮肤和肌内电刺激将有可能缩小关于深部组织传入选择性检查的重要诊断差距，并为非伤害性和伤害性传入的兴奋性提供特定位置的信息。
