Pöyhiä R, Da Costa D, Fitzcharles M A
McGill-MGH Pain Centre, McGill University, Montreal, Quebec, Canada.
Arthritis Rheum. 2001 Aug;45(4):355-61. doi: 10.1002/1529-0131(200108)45:4<355::AID-ART348>3.0.CO;2-K.
To examine the natural clinical course of pain in fibromyalgia (FM) and patients' reports of the use of interventions for pain relief.
This prospective 3-year study examined pain, and the treatment thereof, in a cohort of 82 women with FM, of whom 59 (72%) were reassessed on 3 subsequent occasions. Pain was measured by the following parameters: visual analog scale (VASpain), tender point count (TP), and the occurrence of widespread pain (WP). Function was assessed by the Health Assessment Questionnaire and the Fibromyalgia Impact Questionnaire, and depression and anxiety by the Arthritis Impact Measurement Scales. All treatments for FM were recorded, and patients identified the treatment that they believed had helped their symptoms of FM.
Pain reporting as measured by all parameters decreased significantly for the whole group over the duration of the study. The mean VASpain decreased from 66 to 55, the mean TP count decreased from 13.5 to 10.5, and the number of patients with WP decreased from 100% to 63%. VASpain correlated positively with TP and WP. One third of patients experienced a reduction in pain by at least 30% from baseline as well as a better outcome in overall status of FM. There was a decline in the use of prescribed medications, whereas the use of alternative products increased. Physical treatment modalities were more often perceived to be of benefit than prescribed medications.
We have observed a spontaneous improvement in pain reporting and less medication use in FM patients, suggesting that the course of this condition may be more favorable than has previously been reported.
研究纤维肌痛（FM）患者疼痛的自然临床病程以及患者对缓解疼痛干预措施的使用报告。
这项为期3年的前瞻性研究对82名FM女性患者的疼痛及其治疗情况进行了检查，其中59名（72%）在随后的3个时间点接受了重新评估。通过以下参数测量疼痛：视觉模拟量表（VAS疼痛）、压痛点计数（TP）和广泛性疼痛（WP）的发生情况。通过健康评估问卷和纤维肌痛影响问卷评估功能，通过关节炎影响测量量表评估抑郁和焦虑。记录所有FM治疗方法，患者指出他们认为对其FM症状有帮助的治疗方法。
在研究期间，整个组所有参数测量的疼痛报告均显著下降。平均VAS疼痛从66降至55，平均TP计数从13.5降至10.5，WP患者数量从100%降至63%。VAS疼痛与TP和WP呈正相关。三分之一的患者疼痛从基线水平至少降低了30%，并且FM总体状况有更好的改善。处方药的使用有所下降，而替代产品的使用增加。物理治疗方式比处方药更常被认为有益。
我们观察到FM患者的疼痛报告有自发改善且药物使用减少，这表明这种疾病的病程可能比先前报道的更有利。
