Application of pain pressure threshold test in lumbar intervertebral disc herniation study

Abstract

To quantify pain pressure threshold(PPT) in the patients with lumbar intervertebral disc herniation before and after treatment, and to study the clinical effects of the PPT test in lumbar intervertebral disc herniation. From January to December 2017, 59 patients with lumbar intervertebral disc hernation were treated, and another 59 normal persons were recruited as the normal control group. Visual analogue scale (VAS) was used to measure the patient's subjective pain intensity at admission, and the pain threshold of lumbar posterior joints was measured by the tenderness gauge. The pain threshold was measured three times with an interval of 1 min at the most painful posterior joints and the contralateral posterior joints, and the average value was recorded as the T-value.All patients were treated with one course of conservative treatment (Fengshi spine fixed-point rotation reduction plus routine dehydration and anti-inflammation). VAS score and pain threshold of posterior lumbar joints were measured after the treatment. One lumbar posterior joint was randomly selected in the normal control group to measure the pain threshold. (1)The patient group and the normal control group were comparable. There was no significant difference in age, body height, body weight and BMI between the two groups(P>0.05). (2) The pressure pain threshold test was consistent:variance analysis on the T-value before treatment [(4.72±2.14) kg / cm2, (4.96±2.10) kg / cm2, (5.11±2.09) kg / cm2] of the affected posterior joint, the T-value after treatment [(7.38±2.36) kg / cm2, (7.62±2.51) kg / cm2, (7.58±2.47) kg / cm2], the T-value of before treatment [(7.18±2.80) kg / cm2, (7.19±2.68) kg / cm2, (7.20±2.69) kg / cm2] of the contralateral posterior joint, T value after treatment [(9.54±2.89) kg / cm2, (9.76±3.01) kg / cm2, (9.77±3.09) kg / cm2]; and normal joint T-value [(12.23±1.56) kg / cm2, (12.51±1.48) kg / cm2, (12.6±1.63) kg / cm2] showed that there were no significant differences in the three successive measurements of pain threshold (P>0.05). (3) After conservative treatment, the pain threshold of the affected side[(7.58±2.38) kg / cm2] and the contralateral lumbar posterior joints [(9.70±2.92) kg / cm2] increased significantly, but T-value of the affected side was still lower than that of the contralateral side, and T value of the both sides were lower than that of the normal group [(12.48±1.44) kg / cm2]. The T-value of the affected side and the contralateral side had significant difference between before and after treatment (P<0.05). After treatment, there was significant difference in T-value between the affected side and the contralateral side (P<0.05);there were significant differences in T-value among the affected side, contralateral side and the normal group(P<0.05). (4)Greater the subjective pain intensity of the patient was lower the posterior joint pain threshold of the affected side would be. As the subjective pain intensity decreased, the posterior joint pain threshold of the lumbar spine also increased. There was a significant difference in the VAS score before and after treatment (P<0.05). Multiple regression analysis showed that the correlation coefficient r between the VAS score before and after treatment and the corresponding T-value of the affected side were significantly different(P<0.05), and the corresponding T-value of the contralateral side were not significantly different(P>0.05). The pressure pain threshold test can accurately evaluate the pain intensity and its changing patterns in the lumbar posterior joint. The pain pressure threshold test is clinically significantin the lumbar disc herniation.