Berglund Birgitta, Harju Eva Liz, Kosek Eva, Lindblom Ulf
Institute of Environmental Medicine, Karolinska Institutet and Department of Psychology, Stockholm University, Stockholm, Sweden.
Pain. 2002 Mar;96(1-2):177-87. doi: 10.1016/s0304-3959(01)00443-2.
Somatosensory perception thresholds, perceived intensity, and quality of perceptions were assessed in 20 women with fibromyalgia syndrome (FMS) and in 20 healthy age-matched female controls. All patients and controls scaled perceived intensity and described perceived quality of randomized thermal (Thermotest) and tactile (von Frey filaments) stimulation. Perceived intensity was scaled by free-number magnitude estimation and interindividual comparability was accomplished by Master Scaling. Perceived quality was assessed by choosing verbal descriptors from a list. Thenar was used as a reference for each modality tested. All patients were able to reliably scale perceived intensity at thenar, as well as in pain-affected body areas. Perception thresholds for cold pain, heat pain, cold-pain tolerance and heat-pain tolerance were significantly lower in patients than controls. For cold and tactile stimulation, the master scaled perceived intensities were significantly higher in patients' pain-affected areas, whereas for warmth/heat stimulation, the intensities were significantly lower. In the qualitative perceptual analysis the most striking and significant finding was the aberration of cold-evoked perceptions in all patients: most stimuli in the range of 30-10 degrees C were reported as heat or other paresthetic or dysesthetic perceptions. The perceptual quality of warmth, and of touch, did not differ from the controls. Another aberration was observed in the nociceptive range of thermal and of tactile stimulation as significantly more frequent pain-related descriptors than in controls. This indicates a general nociceptive facilitation in addition to the lower thermal pain thresholds. The combination of cold hyperesthesia, cold dysesthesia, and multimodal hyperalgesia suggests a selective pathophysiology at a particular level of integration, possibly in the insular cortex. It is suggested that the aberrations revealed by the supraliminal sensory evaluation may be generic for FMS. Particularly, the aberrations established in all patients for perceived quality and intensity in the cold sensory channel may be an additional diagnostic criterion.
对20名纤维肌痛综合征（FMS）女性患者和20名年龄匹配的健康女性对照者进行了体感知觉阈值、感知强度和知觉质量评估。所有患者和对照者对随机热刺激（Thermotest）和触觉刺激（von Frey细丝）的感知强度进行评分，并描述感知质量。通过自由数字量级估计对感知强度进行评分，并通过主标度法实现个体间的可比性。通过从列表中选择语言描述符来评估感知质量。将鱼际作为每种测试模式的参考部位。所有患者都能够可靠地对鱼际以及疼痛受累身体部位的感知强度进行评分。患者的冷痛、热痛、冷痛耐受性和热痛耐受性的知觉阈值显著低于对照组。对于冷刺激和触觉刺激，主标度后的患者疼痛受累区域的感知强度显著更高，而对于温热/热刺激，强度则显著更低。在定性知觉分析中，最显著的发现是所有患者冷诱发知觉的异常：30 - 10摄氏度范围内的大多数刺激被报告为热或其他感觉异常或感觉障碍性知觉。温热和触觉的知觉质量与对照组无差异。在热觉和触觉刺激的伤害性感受范围内还观察到另一种异常，即与疼痛相关的描述符比对照组明显更频繁。这表明除了较低的热痛阈值外，还存在普遍的伤害性感受易化。冷觉过敏、冷觉异常和多模式痛觉过敏的组合表明在特定整合水平可能存在选择性病理生理学，可能在岛叶皮质。提示阈上感觉评估所揭示的异常可能是FMS的共性。特别是，所有患者在冷感觉通道中感知质量和强度方面所确定的异常可能是一个额外的诊断标准。
