臺灣博碩士論文加值系統

下背痛除了會影響日常生活及造成工作上的不便之外，還可能因疼痛而失能，造成工作壓力，在過去的25年之內，因背痛失能的病人比率和醫療成本的花費已經呈現上升的趨勢。疼痛的評估除了自陳式量表之外，先前有研究使用心跳速率反應 (heart rate response) 做為疼痛的客觀指標，認為心跳增加與交感神經的活性有關。本論文探討物理因子治療對自主神經調控所造成的影響，期望能找出心率變異性參數與疼痛之間的相關性。我們以頻譜分析測量治療前後之心率變異性，受測者均無高血壓與糖尿病的病史且未使用止痛藥，我們以平躺五分鐘之心電圖訊號來進行心率變異性之頻譜分析，測量值包含RR間距 (RR)、全頻 (TP)、低頻 (LF)、高頻 (HF)、低頻正常化單位 (LF%)、高頻正常化單位 (HF%)、低頻高頻比 (LF/HF)。經統計分析發現治療後的病人其RR、TP、LF及HF皆顯著地上升。依據心率變異性頻譜分析所對應的生理意義，本實驗的結論為下背痛病人接受物理因子治療後，其自主神經整體活性與副交感神經活性顯著地上升，此現象在男性較明顯但在女性則較不明顯。接受物理因子治療後的下背痛病人，其疼痛與失能指數皆顯著下降，不論是男、女性或是腰椎退化性關節炎 (spondylosis)、椎間盤突出 (HIVD) 的病人。

Low back pain (LBP) causes inconvenience in daily life and professional career. The pain might exacerbate disability and increase work load. In the past 25 years, the medical costs for LBP patients have markedly raised.
Previous studies revealed that heart rate response might be an objective indicator for pain. The acceleration of heart rate could be related to enhanced sympathetic activity. The aims of this study were, firstly, to observe the differences of pain, disability and heart rate variability (HRV) parameters after physical agent modalities.
Secondly, we would like to determine any correlations between the changes of pain and HRV parameters. We applied the physical agent modalities on 73 LBP patients (38 men, 35 women). Electrocardiography (ECG) data for analysis were collected before and after treatment. Frequency-domain analysis of the stationary R-R intervals (R-R) was performed to quantify the total power (TP), the low frequency power (LF), the high frequency power (HF), normalized low-frequency power (LF%), normalized high-frequency power (HF%) and the low to high frequency power ratio (LF/HF) of heart rate variability. Pain was evaluation with visual analogue scale and disability was assessed by Oswestry Low Back Pain Disability Questionnaire. To our knowledge, this study is the first to demonstrate increased RR, TP, LF and HF in LBP patients after physical agent modalities. These results indicated that increased parasympathetic regulation in LBP patients after physical agent modalities. These phenomena were also found in 38 male patients rather than 35 female patients. The pain and disability significantly decreased regardless of the gender and disease entity. There was positive correlation between the change percentages of pain and HF% for all and male patients.

致謝辭.................................................................................. Ⅰ
中文摘要.............................................................................. Ⅱ
英文摘要.............................................................................. Ⅲ
目錄...................................................................................... Ⅴ
研究背景.............................................................................. 1
下背痛的流行病學............................................................. 1
下背痛的種類..................................................................... 2
下背痛的治療..................................................................... 3
疼痛與自主神經活性.......................................................... 5
心率變異性與自主神經調控............................................... 6
研究動機與目的.................................................................. 9
研究動機............................................................................... 9
研究目的............................................................................... 9
研究的重要性....................................................................... 10
研究材料與方法.................................................................. 11
研究對象............................................................................... 11
實驗儀器............................................................................... 11
物理因子治療處方............................................................... 11
問卷調查............................................................................... 13
實驗步驟............................................................................... 14
心電圖記錄........................................................................... 18
頻譜分析............................................................................... 19
統計分析............................................................................... 20
研究結果.............................................................................. 21
討論...................................................................................... 25
性別與心率變異性參數的關係........................................... 25
疼痛與心率變異性參數的關係........................................... 26
疾病與心率變異性參數的關係........................................... 26
本論文之檢討..................................................................... 27
結論...................................................................................... 29
附表...................................................................................... 30
附圖...................................................................................... 38
參考文獻.............................................................................. 43
附件...................................................................................... 48

中文部分
施至遠、陳文翔、邱泰源 (2008)。物理治療儀器於復健上之應用。基層醫學，23(6)，163-171

曾雅莉 (2006)。彼拉提斯核心運動介入對下背痛患者的效果探討。國立屏東教育大學體育學系碩士學位論文，屏東市。

廖文炫、張梅蘭、蔡美文、王淑芬 (2002)。物理因子治療學：冷、熱光、水療及機械性治療。臺北：合記圖書出版社。

廖文炫、張梅蘭、蔡美文、王淑芬 (2003)。物理因子治療學：電磁療學。臺北：合記圖書出版社。


英文部分
(1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 17, 354-381.

Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC & Cohen RJ. (1981). Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 213, 220-222.

Appelhans BM & Luecken LJ. (2008). Heart rate variability and pain: associations of two interrelated homeostatic processes. Biol Psychol 77, 174-182.

Biewen PC. (1999). A structured approach to low back pain. Thorough evaluation is the key to effective treatment. Postgrad Med 106, 102-107, 111-104.

Carpenter DM & Nelson BW. (1999). Low back strengthening for the prevention and treatment of low back pain. Med Sci Sports Exerc 31, 18-24.

Clauw DJ, Mease P, Palmer RH, Gendreau RM & Wang Y. (2008). Milnacipran for the treatment of fibromyalgia in adults: a 15-week, multicenter, randomized, double-blind, placebo-controlled, multiple-dose clinical trial. Clin Ther 30, 1988-2004.

Drummond PD. (2003). The effect of pain on changes in heart rate during the Valsalva manoeuvre. Clin Auton Res 13, 316-320.

Frymoyer JW & Gordon SL. (1989). Research perspectives in low-back pain. Report of a 1988 workshop. Spine 14, 1384-1390.

Gijsbers K & Nicholson F. (2005). Experimental pain thresholds influenced by sex of experimenter. Percept Mot Skills 101, 803-807.

Gupta RC & Ramarao SV. (1978). Epidurography in reduction of lumbar disc prolapse by traction. Arch Phys Med Rehabil 59, 322-327.

Harte AA, Gracey JH & Baxter GD. (2005). Current use of lumbar traction in the management of low back pain: results of a survey of physiotherapists in the United Kingdom. Arch Phys Med Rehabil 86, 1164-1169.

Heller PH, Perry F, Naifeh K, Gordon NC, Wachter-Shikura N & Levine J. (1984). Cardiovascular autonomic response during preoperative stress and postoperative pain. Pain 18, 33-40.

Kofotolis N & Sambanis M. (2005). The influence of exercise on musculoskeletal disorders of the lumbar spine. J Sports Med Phys Fitness 45, 84-92.

Kuo TBJ, Lin T, Yang CCH, Li CL, Chen CF & Chou P. (1999). Effect of aging on gender differences in neural control of heart rate. Am J Physiol 277, H2233-2239.

Levine FM & De Simone LL. (1991). The effects of experimenter gender on pain report in male and female subjects. Pain 44, 69-72.

Luczak H & Laurig W. (1973). An analysis of heart rate variability. Ergonomics 16, 85-97.

Mathews JA. (1968). Dynamic discography: a study of lumbar traction. Ann Phys Med 9, 275-279.

McCaffery M & Wolff M. (1992). Pain relief using cutaneous modalities, positioning, and movement. Hosp J 8, 121-153.

Newcomer KL, Jacobson TD, Gabriel DA, Larson DR, Brey RH & An KN. (2002). Muscle activation patterns in subjects with and without low back pain. Arch Phys Med Rehabil 83, 816-821.

Nordin M, Welser S, Campello MA & Pietrek M. (2002). Self-care techniques for acute episodes of low back pain. Best Pract Res Clin Rheumatol 16, 89-104.

Onel D, Tuzlaci M, Sari H & Demir K. (1989). Computed tomographic investigation of the effect of traction on lumbar disc herniations. Spine 14, 82-90.

Quittan M. (2002). Management of back pain. Disabil Rehabil 24, 423-434.

Sayers BM. (1973). Analysis of heart rate variability. Ergonomics 16, 17-32.

Tekeoglu I, Adak B, Bozkurt M & Gurbuzoglu N. (1998). Distraction of lumbar vertebrae in gravitational traction. Spine 23, 1061-1063; discussion 1064.

Tousignant-Laflamme Y, Rainville P & Marchand S. (2005). Establishing a link between heart rate and pain in healthy subjects: a gender effect. J Pain 6, 341-347.

Von Korff M, Dworkin SF, Le Resche L & Kruger A. (1988). An epidemiologic comparison of pain complaints. Pain 32, 173-183.

Walker BF. (2000). The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 13, 205-217.

Waxman R, Tennant A & Helliwell P. (1998). Community survey of factors associated with consultation for low back pain. Bmj 317, 1564-1567.

Webster BS & Snook SH. (1990). The cost of compensable low back pain. J Occup Med 32, 13-15.

Wolf MM, Varigos GA, Hunt D & Sloman JG. (1978). Sinus arrhythmia in acute myocardial infarction. Med J Aust 2, 52-53.