伴有和不伴有纤维肌痛的肠易激综合征患者的热敏感性和内脏超敏反应
Thermal and visceral hypersensitivity in irritable bowel syndrome patients with and without fibromyalgia.
作者信息
Moshiree Baharak, Price Donald D, Robinson Michael E, Gaible Ryan, Verne G Nicholas
机构信息
Department of Medicine, University of Florida Colleges of Medicine, Dentistry, Public Health and Health Professions, Gainesville, FL 32610-0214, USA.
出版信息
Clin J Pain. 2007 May;23(4):323-30. doi: 10.1097/AJP.0b013e318032e496.
BACKGROUND
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by both visceral and somatic hyperalgesia, producing a similar effect seen with the central hypersensitivity mechanism in fibromyalgia (FM).
OBJECTIVES
The aim of the current study was to compare magnitudes of visceral and thermal hypersensitivity in IBS patients and FM patients with IBS (FM+IBS) compared with healthy controls.
METHODS
Female patients with IBS (n=12), FM+IBS (n=12), and control participants (n=13) rated pain intensity to hot water immersion (45 and 47 degrees C) of the hand/foot and to phasic distension of the rectum (35, 55 mm Hg) on a Mechanical Visual Analog Scale. The data were analyzed with 3 separate 1-way analyses of variance with post hoc Tukey tests.
RESULTS
For both thermal and visceral stimuli, the control group had lower pain ratings than either the IBS or FM+IBS groups (P<0.001). IBS patients rated rectal distension as more painful than the FM+IBS group (P=0.005). During hot water immersion of the foot, the FM+IBS group had higher pain ratings than the IBS group (P<0.001). During hand immersion, FM+IBS and IBS patients did not significantly differ in their pain intensity ratings (P=0.4).
CONCLUSIONS
FM+IBS patients show greater thermal hypersensitivity compared with IBS patients. However, IBS patients exhibit higher pain ratings to rectal distension compared with FM+IBS patients. This data suggests that regions of primary and secondary hyperalgesia are dependent on the primary pain complaint.
背景
肠易激综合征(IBS)是一种慢性胃肠道疾病,其特征为内脏和躯体痛觉过敏,产生与纤维肌痛(FM)中枢性超敏反应机制类似的效应。
目的
本研究旨在比较肠易激综合征患者和合并肠易激综合征的纤维肌痛患者(FM+IBS)与健康对照者的内脏和热超敏程度。
方法
肠易激综合征女性患者(n=12)、FM+IBS女性患者(n=12)和对照参与者(n=13)使用机械视觉模拟量表对手/足进行热水浸泡(45和47摄氏度)以及对直肠进行阶段性扩张(35、55毫米汞柱)时的疼痛强度进行评分。数据采用3项独立的单因素方差分析及事后Tukey检验进行分析。
结果
对于热刺激和内脏刺激,对照组的疼痛评分均低于肠易激综合征组和FM+IBS组(P<0.001)。肠易激综合征患者对直肠扩张的疼痛评分高于FM+IBS组(P=0.005)。在足部热水浸泡期间,FM+IBS组的疼痛评分高于肠易激综合征组(P<0.001)。在手部浸泡期间,FM+IBS患者和肠易激综合征患者的疼痛强度评分无显著差异(P=0.4)。
结论
与肠易激综合征患者相比,FM+IBS患者表现出更高的热超敏性。然而,与FM+IBS患者相比,肠易激综合征患者对直肠扩张的疼痛评分更高。该数据表明原发性和继发性痛觉过敏区域取决于主要疼痛主诉。