Dunphy Rebecca C, Bridgewater Lee, Price Donald D, Robinson Michael E, Zeilman Charles J, Verne G Nicholas
Malcom Randall VAMC, Research Service, 1601 SW Archer Road, Gainesville, FL, USA.
Pain. 2003 Mar;102(1-2):79-85. doi: 10.1016/s0304-3959(02)00342-1.
Approximately 697000 United States military personnel participated in the Persian Gulf War (PGW) between August 1990 and March 1991. By April 1997, over 25% of veterans reported chronic health complaints of underdetermined etiology. Gastrointestinal symptoms were among the most frequently reported symptoms including abdominal pain and diarrhea. The objectives of this study were (1). to determine if PGW veterans chronic abdominal pain and diarrhea exhibit visceral and cutaneous hypersensitivity, (2). to determine if these differences in pain sensitivity are significantly associated with psychological stress. A total of 12 veterans (ten males, two females) (39+/-9 years) who were deployed to the Persian Gulf were enrolled. Seven civilians without prior military experience (five males, two females) and five veterans (five males) who had previously been deployed for active combat were enrolled as controls (35+/-9 years). All 12 PGW veterans reported chronic abdominal pain and diarrhea (negative diagnostic workup) that developed during their tour of duty in the Persian Gulf region. All patients completed a battery of psychological assessments and then randomly received experimental visceral (rectal distension of 35 and 55 mmHg for 30s) and cutaneous (immersion of right foot in 45 and 47 degrees C water for 30s) pain stimuli after which they rated their pain intensity and pain unpleasantness on a continuous visual analogue scale (M-VAS) scale. The trials were repeated and the mean M-VAS scores for the two trials were recorded for each subject. In comparison to controls, PGW subjects reported statistically significant higher mean ratings of pain intensity and pain unpleasantness in response to 35 and 55 mmHg rectal distention (P<0.001) and in response to 45 and 47 degrees C water immersion (P<0.001) of the hand and foot. Results of the hierarchical regressions indicated that the psychological measures (i.e. anxiety, somatic focus) accounted for a significant amount of variance in each of the pain measures. PGW veterans who developed chronic abdominal pain and diarrhea during their tour of duty exhibit visceral hypersensitivity similar to patients with the irritable bowel syndrome. These veterans also have cutaneous hypersensitivity and higher levels of anxiety and somatic focus accounting for these differences in pain reporting.
1990年8月至1991年3月期间，约69.7万名美国军事人员参加了海湾战争（PGW）。到1997年4月，超过25%的退伍军人报告有病因不明的慢性健康问题。胃肠道症状是最常报告的症状之一，包括腹痛和腹泻。本研究的目的是：（1）确定海湾战争退伍军人的慢性腹痛和腹泻是否表现出内脏和皮肤超敏反应；（2）确定这些疼痛敏感性差异是否与心理压力显著相关。总共招募了12名被派往波斯湾的退伍军人（10名男性，2名女性）（39±9岁）。招募了7名无军事经验的平民（5名男性，2名女性）和5名曾参加过实战部署的退伍军人（5名男性）作为对照（35±9岁）。所有12名海湾战争退伍军人都报告在波斯湾地区服役期间出现了慢性腹痛和腹泻（诊断检查为阴性）。所有患者完成了一系列心理评估，然后随机接受实验性内脏（分别以35和55 mmHg的压力直肠扩张30秒）和皮肤（将右脚浸入45和47摄氏度的水中30秒）疼痛刺激，之后他们在连续视觉模拟量表（M-VAS）上对疼痛强度和疼痛不适感进行评分。试验重复进行，并记录每个受试者两次试验的平均M-VAS分数。与对照组相比，海湾战争受试者在直肠扩张至35和55 mmHg（P<0.001）以及手脚浸入45和47摄氏度的水（P<0.001）时，报告的疼痛强度和疼痛不适感的平均评分在统计学上显著更高。分层回归结果表明，心理测量指标（即焦虑、躯体关注）在每种疼痛测量指标中都占了很大比例的方差。在服役期间出现慢性腹痛和腹泻的海湾战争退伍军人表现出与肠易激综合征患者相似的内脏超敏反应。这些退伍军人还存在皮肤超敏反应，以及更高水平的焦虑和躯体关注，这解释了他们在疼痛报告上的这些差异。
