McLean Samuel A, Williams David A, Stein Phyllis K, Harris Richard E, Lyden Angela K, Whalen Gail, Park Karen M, Liberzon Israel, Sen Ananda, Gracely Richard H, Baraniuk James N, Clauw Daniel J
Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
Neuropsychopharmacology. 2006 Dec;31(12):2776-82. doi: 10.1038/sj.npp.1301200. Epub 2006 Aug 23.
Previous studies have identified stress system dysregulation in fibromyalgia (FM) patients; such dysregulation may be involved in the generation and/or maintenance of pain and other symptoms. Corticotropin-releasing factor (CRF) is the principal known central nervous system mediator of the stress response; however, to date no studies have examined cerebrospinal fluid (CSF) CRF levels in patients with FM. The relationship between CSF CRF level, heart rate variability (HRV), and pain, fatigue, and depressive symptoms was examined in patients with FM. Among participants (n=26), CSF CRF levels were associated with sensory pain symptoms (r=0.574, p=0.003) and affective pain symptoms (r=0.497, p=0.011), but not fatigue symptoms. Increased HRV was also strongly associated with increased CSF CRF and FM pain. In multivariate analyses adjusting for age, sex, and depressive symptoms, the association between CSF CRF and sensory pain symptoms (t=2.54, p=0.027) persisted. Women with FM who reported a history of physical or sexual abuse had lower CSF CRF levels than women who did not report such a history. CSF CRF levels are associated with both pain symptoms and variation in autonomic function in FM. Differences in CSF CRF levels among women with and without a self-reported history of physical or sexual abuse suggest that subgroups of FM patients may exist with different neurobiological characteristics. Further studies are needed to better understand the nature of the association between CSF CRF and pain symptoms in FM.
以往研究已确定纤维肌痛（FM）患者存在应激系统失调；这种失调可能参与疼痛及其他症状的产生和/或维持。促肾上腺皮质激素释放因子（CRF）是已知的应激反应主要中枢神经系统介质；然而，迄今为止尚无研究检测FM患者的脑脊液（CSF）CRF水平。本研究检测了FM患者脑脊液CRF水平、心率变异性（HRV）与疼痛、疲劳及抑郁症状之间的关系。在参与者（n = 26）中，脑脊液CRF水平与感觉性疼痛症状（r = 0.574，p = 0.003）和情感性疼痛症状（r = 0.497，p = 0.011）相关，但与疲劳症状无关。HRV增加也与脑脊液CRF增加及FM疼痛密切相关。在对年龄、性别和抑郁症状进行校正的多变量分析中，脑脊液CRF与感觉性疼痛症状之间的关联（t = 2.54，p = 0.027）依然存在。报告有身体或性虐待史的FM女性脑脊液CRF水平低于未报告此类病史的女性。脑脊液CRF水平与FM的疼痛症状及自主神经功能变化均相关。有或无自我报告身体或性虐待史的女性脑脊液CRF水平存在差异，提示可能存在具有不同神经生物学特征的FM患者亚组。需要进一步研究以更好地理解FM患者脑脊液CRF与疼痛症状之间关联的本质。
