腕隧道症候群病患的疼痛與神經損傷狀況之探討

Studies of pain and nerve damage condition in Carpal Tunnel Syndrome

劉雅棻(Ya-Fen Liu)

指導教授 ： 呂怡靜

高雄醫學大學/醫學院/神經學科研究所/碩士(2009年)

https://doi.org/10.6832/KMU.2009.00013

摘要

研究目的:腕隧道症候群(carpal tunnel syndrome, CTS)為神經受壓迫的神經病變疾病，疼痛是組織受到傷害而發出的警訊，但關於疼痛與神經損傷間的研究仍不足。本研究目的欲了解CTS疼痛情形並探討疼痛與神經損傷的關係。研究方法:先以泛文化改編發展中文版波士頓腕隧道量表(Boston Carpal Tunnel Questionnaire, BCTQ)，作為後續研究疼痛評估使用，再進行疼痛與神經損傷的探討。病患以中文版BCTQ及視覺類比分數(Visual Analogue Scale, VAS)來量化其自覺疼痛，以神經電生理學檢查及溫度感覺量化測試分別評估大直徑神經纖維及小直徑神經纖維的損傷情形。研究結果: 中文版BCTQ具良好信效度。疼痛情形方面，123位CTS病患中約60%有疼痛症狀。BCTQ症狀嚴重程度的第一至五題，文字內容可評估疼痛的有無、程度、頻率及發生時間，適合CTS疼痛評估用。疼痛與神經損傷情形方面，以溫度感覺量化測試顯示CTS及健康對照組在冷溫度閾值(p=0.03)與熱溫度閾值(p=0.01)有顯著差異。再將受試者分為病患疼痛組、病患無疼痛組及健康對照組，冷溫度閾值(p=0.003)及熱溫度閾值(p=0.017)三組間具顯著差異，經事後檢定在病患疼痛與病患無疼痛間，冷溫度閾值有顯著差異(p=0.038)。神經電生理學部分，依神經生理綜合分級病患最多為第三級嚴重程度(33.3%)，遠端運動潛期(distal motor latency)與BCTQ整體疼痛有中度正相關(rho=0.39)。疼痛組及無疼痛組兩組間的遠端運動潛期有顯著差異(p=0.008)。以邏輯迴歸分析探討大小直徑神經損傷情形是否造成疼痛，只有遠端運動潛期具有顯著意義(p=0.03)，代表疼痛可能是由大直徑神經纖維損傷所造成。結論: 中文版BCTQ適合做為CTS疼痛評估用。CTS病患冷、熱溫度閾值比正常人閾值較高、較為遲鈍，可能有小直徑神經纖維的損傷。藉本研究可了解CTS疼痛情形與評估方法以及疼痛的發生與神經損傷的關係，做為臨床CTS疼痛與神經損傷情形評估的參考。

關鍵字

腕隧道症候群 ； 波士頓腕隧道量表 ； 溫度感覺量化測試

並列摘要

Background and purpose: Carpal tunnel syndrome (CTS) is a
neuropathic condition caused by nerve compression. The pain is an alert as a result of tissue damaged. Research on the relationship between pain and nerve damage however is still insufficient. The aim of this study was to understand pain caused by CTS and to assess the association between pain and the status of nerve damage. Methods: We developed and translated the Chinese version of the Boston Carpal Tunnel Questionnaire (BCTQ) through cross-cultural adaptation process for pain assessment and examined pain and the nerve damage condition. Patients quantified their pain level using the Visual Analogue Scale (VAS) and the Chinese BCTQ. The degree of the large myelinated nerve fiber damage was assessed by using the nerve conduction studies (NCS), and the damage status of the small nerve fiber was quantified by using the thermal quantitative sensory testing (QST). Results: The Chinese version of BCTQ showed good reliability and validity. Pain symptoms were found in approximately 60% of the 123 CTS patients. The first five questions of BCTQ symptom severity scale were suitable for CTS pain assessment, as the contents included assessment of pain intensity, frequency, and pain at day or night. CTS patients and healthy controls were significantly different in the cold detection threshold (CDT) (p=0.03) and the warm detection threshold (WDT) (p=0.01). When comparing painful and painless CTS with the control group, significant differences were found in CDT (p=0.003) and WDT (p=0.017). Post-hot analysis found significant difference between the painful and painless CTS groups in CDT (p=0.038). The third grade of neurophysiological grading scale was most common (33.3%). A moderate positive correlation was found between distal motor latency and the first five questions of BCTQ (rho=0.39). There was significant difference between painful and painless CTS in distal motor latency (p=0.008).When examining the presence of pain and large or small nerve fibers damage conditions using logistic regression, distal motor latency was the only significant independent variable (p=0.03). It implies that pain maybe caused by the damage status of large nerve fibers mainly. Conclusion: Chinese version of BCTQ is suitable for assessing pain symptoms in CTS. CTS patients may have abnormal small nerve fiber function, and with higher CDT and WDT than healthy controls. Our results shed some light on suitable scale for pain assessment and the relationship between pain and nerve damage condition in CTS.

並列關鍵字

Carpal tunnel syndrome ； BCTQ ； QST ； pain ； nerve damage

參考文獻

參考文獻

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