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2019, vol. 72, br. 3-4, str. 66-71
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Procena uslovne modulacije bola izazvane korišćenjem kontaktne toplote kao uslovljavajućeg stimulusa i dva različita test stimulusa
Conditioned pain modulation assessment using contact heat as conditioning stimulus and two different test stimuli
aUniverzitet u Novom Sadu, Medicinski fakultet + Klinički centar Vojvodine, Klinika za medicinsku rehabilitaciju, Novi Sad bUniverzitet u Novom Sadu, Medicinski fakultet
e-adresa: aleksandar.knezevic@mf.uns.ac.rs
Sažetak
Uvod. Cilj ove studije bio je da se utvrdi potencijal i pouzdanost izazivanja efekta uslovne modulacije bola u zdravoj populaciji korišćenjem lokalno aplikovane toplote kao uslovljavajućeg stimulusa, a toplote i pritiska aplikovane na donji deo leđa kao test-stimulusa. Materijal i metode. Istraživanje je obuhvatilo 33 zdrava ispitanika (prosečne starosti 25,73 ± 5,35 godina). Kao test-stimulusi ispitivani su pragovi za bol za pritisak i toplotu na paravertebralnoj muskulaturi donjeg dela leđa. Kontaktna toplota je primenjena na kontralateralnoj podlaktici kao uslovljavajući stimulus. Uslovna modulacija bola izračunata je kao razlika između pragova bola nakon i pre primene stimulusa. Kako bi se procenila pouzdanost protokola, identično ispitivanje je sprovedeno nakon 14 ± 2 dana. Rezultati. Prag bola za pritisak i toplotu koji su dobijeni nakon uslovljavajućeg stimulusa bili su značajno viši u poređenju sa pragovima bola dobijenim pre primene ovog stimulusa (101,63 N/cm2 ± 45,21 N/cm2 vs 82,15 N/cm2 ± 36,15 N/cm2 , t = -7,528, p < 0,001 i 47,08o C ± 2,19o C vs 45 ± 3,05o C, t = -6,644, p < 0,001, respektivno). Procena pouzdanosti protokola, merena 14 ± 2 dana nakon inicijalnog ispitivanja pokazala je dobru pouzdanost za prag bola za pritisak (ICC = 0,636, 95% CI 0,240 ̶ 0,825) i osrednju za prag bola za toplo (ICC = 0,435, 95% CI -0,070 ̶ 0,713). Zaključak. Kontaktna toplota aplikovana preko termode pokazala se kao efikasan uslovljavajući stimulus jer je uspešno indukovala uslovnu modulaciju bola. Puzdanost ovog načina testiranja pokazala se kao osrednja kada je bio u pitanju prag bola za toplo, odnosno dobra kada je u pitanju bio prag bola za pritisak.
Abstract
Introduction. The objective of the study was to determine the potentials and reliability of conditioned pain modulation effect in healthy population by application of a conditioning contact heat stimulus, and heat and pressure applied to the low back region as a test stimulus. Material and Methods. The study included 33 healthy subjects (average age 25.73 ± 5.35 years). Pressure and heat pain thresholds were examined on the paravertebral musculature of the lower back as test stimuli. Contact heat was used on the contralateral forearm as a conditioning stimulus. Conditioned pain modulation was calculated as the difference between pain thresholds after and before conditioning stimulus application. To assess the reliability, identical testing was performed 14 ± 2 days later. Results. The pressure and heat pain thresholds, after the conditioning stimulus, were significantly higher compared to pain thresholds obtained before the conditioning stimulus (101,63 N/cm2 ± 45,21N/cm2 vs 82,15 N/cm2 ± 36,15 N/cm2 , t = -7,528, p < 0,001 and 47,08o C ± 2,19o C vs 45,00 ± 3,05o C, t = -6,644, p < 0,001, respectively). The reliability of the same protocol, measured 14 ± 2 days after the previous testing, showed good reliability of the pressure pain threshold (intraclass correlation coefficient = 0,636, 95% confidence interval 0,240 - 0,825), and fair of the heat pain threshold (intraclass correlation coefficient = 0,435, 95% confidence interval - 0,070 - 0,713). Conclusion. Conditioned pain modulation was successfully induced by contact heat applied via a thermode, a conditioning stimulus. The reliability of this method of testing proved to be fair when it comes to the heat pain threshold and good when it comes to the pressure pain threshold.
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