Carli Giancarlo, Suman Anna Lisa, Biasi Giovanni, Marcolongo Roberto
Istituto di Fisiologia Umana and Istituto di Reumatologia, Università degli Studi, 53100, Siena, Italy.
Pain. 2002 Dec;100(3):259-269. doi: 10.1016/S0304-3959(02)00297-X.
In this study, we evaluated pain sensitivity in patients with fibromyalgia or other types of chronic, diffuse musculoskeletal pain to establish whether fibromyalgia represents the end of a continuum of dysfunction in the nociceptive system. One hundred and forty five patients and 22 healthy subjects (HS) completed an epidemiological questionnaire to provide information about fatigue, stiffness, sleep, the intensity of pain (VAS 0-100) and its extent both at onset and at present. Algometry was performed at all American College of Rheumatology (ACR) tender points and at ten control points. Patients were divided into five main groups: fibromyalgia (FS) patients, secondary-concomitant fibromyalgia (SCFS) patients, patients with widespread pain (WP) but not reaching the ACR criterion of 11 tender points, patients with diffuse multiregional pain (MP) not reaching the ACR criteria (widespread pain, tender point counts), and patients with multiregional pain associated with at least 11 tender points (MPTE). von Frey monofilaments were used to assess superficial punctate pressure pain thresholds. Heat and cold pain thresholds were determined with a thermal stimulator. Ischemic pain was assessed by the cold pressure test and the submaximal effort tourniquet test. The scores for stiffness and present pain intensity gradually increased concomitantly with the increase in tender point count and pain extent. The pressure pain thresholds for positive tender and positive control points were significantly lower in the SCFS, FS and MPTE groups than in HS, MP and WP groups, the latter three groups displaying similar values. In all groups, there were no differences in pain thresholds between positive tender and positive control points. The heat pain threshold and the pain threshold in the cold pressure test were lower in the FS and SCFS groups than in HS. The cold pressure tolerance was lower in patients with widespread pain than in HS. In the von Frey test, all patient groups except MP had similar values, which were significantly lower than in HS. Finally, all patient groups displayed lower tourniquet tolerance than HS. In each psychophysical test, patients with widespread pain and patients with multiregional pain showed similar thresholds; however, the thresholds in the MP or MPTE groups differed from those in the FS and SCFS groups. In the FS group, pain thresholds and pain tolerance did not differ according to the presence of ongoing pain at the stimulated site and were not correlated to ongoing pain. The results indicate that dysfunction in the nociceptive system is already present in patients with multiregional pain with a low tender point count; it becomes more and more severe as the positive tender point count and pain extent increase and it is maximal in fibromyalgia patients.
在本研究中，我们评估了纤维肌痛患者或其他类型慢性弥漫性肌肉骨骼疼痛患者的疼痛敏感性，以确定纤维肌痛是否代表伤害感受系统功能障碍连续体的终点。145例患者和22名健康受试者（HS）完成了一份流行病学调查问卷，以提供有关疲劳、僵硬、睡眠、疼痛强度（视觉模拟评分0 - 100）及其发作时和目前程度的信息。在所有美国风湿病学会（ACR）压痛点和10个对照点进行压痛测定。患者分为五个主要组：纤维肌痛（FS）患者、继发性伴发性纤维肌痛（SCFS）患者、有广泛疼痛（WP）但未达到ACR标准11个压痛点的患者、有弥漫性多区域疼痛（MP）但未达到ACR标准（广泛疼痛、压痛点计数）的患者以及有至少11个压痛点的多区域疼痛（MPTE）患者。使用von Frey单丝评估浅表点状压痛阈值。用热刺激器测定热痛和冷痛阈值。通过冷压试验和次最大用力止血带试验评估缺血性疼痛。僵硬和当前疼痛强度评分随着压痛点计数和疼痛范围的增加而逐渐升高。SCFS、FS和MPTE组中阳性压痛点和阳性对照点的压痛阈值显著低于HS、MP和WP组，后三组显示出相似的值。在所有组中，阳性压痛点和阳性对照点之间的疼痛阈值没有差异。FS和SCFS组的热痛阈值和冷压试验中的疼痛阈值低于HS组。广泛疼痛患者的冷压耐受性低于HS组。在von Frey试验中，除MP组外的所有患者组的值相似，均显著低于HS组。最后，所有患者组的止血带耐受性均低于HS组。在每项心理物理学测试中，广泛疼痛患者和多区域疼痛患者表现出相似的阈值；然而，MP或MPTE组的阈值与FS和SCFS组不同。在FS组中，疼痛阈值和疼痛耐受性与刺激部位是否存在持续性疼痛无关，且与持续性疼痛不相关。结果表明，伤害感受系统功能障碍在压痛点计数低的多区域疼痛患者中已经存在；随着阳性压痛点计数和疼痛范围的增加，功能障碍越来越严重，在纤维肌痛患者中最为严重。
