Chang L, Mayer E A, Johnson T, FitzGerald L Z, Naliboff B
UCLA/CURE Neuroenteric Disease Program, Departments of Medicine and Physiology, UCLA School of Medicine, Los Angeles, CA 90024, USA.
Pain. 2000 Feb;84(2-3):297-307. doi: 10.1016/s0304-3959(99)00215-8.
Irritable bowel syndrome (IBS) and fibromyalgia (FM) are considered chronic syndromes of altered visceral and somatic perception, respectively. Because there is a significant overlap of IBS and FM, shared pathophysiological mechanisms have been suggested. Although visceral perception has been well studied in IBS, somatic perception has not.
To compare hypervigilance and altered sensory perception in response to somatic stimuli in patients with IBS, IBS+FM, and healthy controls.
Eleven IBS females (mean age 40), 11 IBS+FM females (mean age 46), and ten healthy female controls (mean age 39) rated pain perception in response to pressure stimuli administered to active somatic tender points, non-tender control points and the T-12 dermatome, delivered in a predictable ascending series, and delivered in an unpredictable randomized fashion (fixed stimulus).
Although IBS patients had similar pain thresholds during the ascending series compared with controls, they were found to have somatic hypoalgesia with higher pain thresholds and lower pain frequency and severity during fixed stimulus series compared with IBS+FM patients and controls (P<0.05). Patients with IBS+FM were more bothered by the somatic stimuli and had somatic hyperalgesia with lower pain thresholds and higher pain frequency and severity.
Both hypervigilance and somatic hypoalgesia contribute to the altered somatic perception in IBS patients. Co-morbidity with FM results in somatic hyperalgesia in IBS patients.
肠易激综合征(IBS)和纤维肌痛(FM)分别被认为是内脏和躯体感觉改变的慢性综合征。由于IBS和FM存在显著重叠,因此有人提出了共同的病理生理机制。虽然内脏感觉在IBS中已得到充分研究,但躯体感觉尚未得到充分研究。
比较IBS患者、IBS+FM患者和健康对照者对躯体刺激的过度警觉和感觉改变。
11名IBS女性患者(平均年龄40岁)、11名IBS+FM女性患者(平均年龄46岁)和10名健康女性对照者(平均年龄39岁)对施加于主动躯体压痛点、非压痛点对照点和T-12皮节的压力刺激的疼痛感觉进行评分,刺激以可预测的递增序列并以不可预测的随机方式(固定刺激)施加。
虽然IBS患者在递增序列期间的疼痛阈值与对照组相似,但与IBS+FM患者和对照组相比,在固定刺激序列期间,他们存在躯体痛觉减退,疼痛阈值更高,疼痛频率和严重程度更低(P<0.05)。IBS+FM患者更容易受到躯体刺激的困扰,存在躯体痛觉过敏,疼痛阈值更低,疼痛频率和严重程度更高。
过度警觉和躯体痛觉减退均导致IBS患者的躯体感觉改变。与FM共病导致IBS患者出现躯体痛觉过敏。