第一次学习,疼痛感知,疼痛敏感性,与对照组相比,青少年特发性关节炎(JIA)病程较长的年轻人的自我报告疼痛。
来自挪威中部的儿童在1997年至2004年间被诊断为JIA,被连续纳入一项基于人群的前瞻性研究。1997-2000年发病的儿童是北欧JIA队列的一部分。对照是年龄和性别匹配的。在2015-2017年,研究访问了研究者盲定量感觉测试(QST),包括冷和热检测阈值(CDT/WDT),冷热痛阈值(CPT/HPT),压力痛阈值(PPT),并进行了超阈值热痛试验。我们为每个检测变量和疼痛阈值构建了单独的多水平模型,并根据年龄和性别的影响调整了组和部位之间的相互作用。
在96名患有JIA的年轻人中,71%是女性,中位年龄为22.7岁,病程为16.1年,47%患有少关节疾病。在109个控件中,71%是女性,中位年龄为23.5岁.与对照组相比,JIA参与者的压力疼痛阈值(PPTs)(95%CI)较低,上肢888(846,930)对1029(999,1059)kPa,下肢702(670,734)对760(726,794)kPa。患有非活动疾病的参与者的PPTs和冷痛阈值(CPTs)最低,与那些缓解药物和患有活动性疾病的人相比。与对照组相比,JIA中CDT/WDT和CPT/HPT的差异很小。在超阈值热痛测试中,在0-10数字评定量表(NRS)上引起疼痛所需的中位数(IQR)温度=6,JIA低于对照组(46°C(45-47°C)对47°C(46-48°C))。我们发现自我报告的疼痛和疼痛阈值之间没有关联。
我们的结果首次表明,与对照组相比,JIA疾病持续时间长的年轻人可能改变了疼痛感知和敏感性。临床意义可能是早期治疗以快速实现无痛缓解并避免长期疼痛致敏的重要性。
To
study for the first-time, pain perception, pain sensitivity, and self-reported pain in young adults with long disease duration of juvenile idiopathic arthritis (JIA) compared with controls.
Children from Central Norway diagnosed with JIA between 1997 and 2004 were included consecutively in a population-based prospective
study. Children with onset 1997-2000 were part of the Nordic JIA cohort. Controls were age- and sex-matched. In 2015-2017,
study visits with investigator-blinded quantitative sensory testing (QST) comprising cold and warm detection thresholds (CDT/WDT), cold and heat pain thresholds (CPT/HPT), pressure pain threshold (PPT), and a suprathreshold heat pain test were performed. We constructed separate multilevel models for each variable of detection and pain thresholds with interaction between groups and site adjusted for the effect of age and sex.
Among 96 young adults with JIA, 71% were female, median age was 22.7 years, disease duration was 16.1 years, and 47% had oligoarticular disease. Among 109 controls, 71% were female, and median age was 23.5 years. Participants with JIA had lower pressure pain thresholds (PPTs) (95% CI) compared to controls, upper limb 888 (846,930) versus 1029 (999,1059) kPa and lower limb 702 (670,734) versus 760 (726,794) kPa. Participants with inactive disease had the lowest PPTs and cold pain thresholds (CPTs), compared to those in remission off medication and those with active disease. Minor differences were found regarding CDT/WDT and CPT/HPT in JIA compared to controls. The median (IQR) temperature needed to evoke pain = 6 on a 0-10 numeric rating scale (NRS) in the suprathreshold heat pain tests were lower in JIA than in controls (46 °C (45-47 °C) versus 47 °C (46-48 °C)). We found no associations between self-reported pain and pain thresholds.
Our results indicate for the first time that young adults with long disease duration of JIA may have altered pain perception and sensitivity compared to controls. A clinical implication may be the importance of early treatment to quickly achieve pain-free remission and avoid long-term pain sensitization.