Centre for Digestive Diseases, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
Neurogastroenterol Motil. 2014 Jan;26(1):139-48. doi: 10.1111/nmo.12245. Epub 2013 Oct 18.
Despite chronic pain being a feature of functional chest pain (FCP) its experience is variable. The factors responsible for this variability remain unresolved. We aimed to address these knowledge gaps, hypothesizing that the psychophysiological profiles of FCP patients will be distinct from healthy subjects.
20 Rome III defined FCP patients (nine males, mean age 38.7 years, range 28-59 years) and 20 healthy age-, sex-, and ethnicity-matched controls (nine males, mean 38.2 years, range 24-49) had anxiety, depression, and personality traits measured. Subjects had sympathetic and parasympathetic nervous system parameters measured at baseline and continuously thereafter. Subjects received standardized somatic (nail bed pressure) and visceral (esophageal balloon distension) stimuli to pain tolerance. Venous blood was sampled for cortisol at baseline, post somatic pain and post visceral pain.
Patients had higher neuroticism, state and trait anxiety, and depression scores but lower extroversion scores vs controls (all p < 0.005). Patients tolerated less somatic (p < 0.0001) and visceral stimulus (p = 0.009) and had a higher cortisol at baseline, and following pain (all p < 0.001). At baseline, patients had a higher sympathetic tone (p = 0.04), whereas in response to pain they increased their parasympathetic tone (p ≤ 0.008). The amalgamating the data, we identified two psychophysiologically distinct 'pain clusters'. Patients were overrepresented in the cluster characterized by high neuroticism, trait anxiety, baseline cortisol, pain hypersensitivity, and parasympathetic response to pain (all p < 0.03).
CONCLUSIONS & INFERENCES: In future, such delineations in FCP populations may facilitate individualization of treatment based on psychophysiological profiling.
尽管功能性胸痛（FCP）的特征是慢性疼痛，但患者的疼痛体验存在差异。导致这种差异的因素仍未得到解决。我们旨在解决这些知识空白，假设 FCP 患者的心理生理学特征将与健康受试者明显不同。
20 名符合罗马 III 标准的 FCP 患者（9 名男性，平均年龄 38.7 岁，范围 28-59 岁）和 20 名年龄、性别和种族匹配的健康对照者（9 名男性，平均年龄 38.2 岁，范围 24-49 岁）进行焦虑、抑郁和人格特质测量。受试者在基线和此后连续进行自主神经和副交感神经系统参数测量。受试者接受标准化躯体（指甲床压力）和内脏（食管球囊扩张）刺激以耐受疼痛。在基线、躯体疼痛后和内脏疼痛后采集静脉血样以测定皮质醇。
与对照组相比，患者的神经质、状态和特质焦虑以及抑郁评分较高，但外向评分较低（均 P<0.005）。患者对躯体刺激（P<0.0001）和内脏刺激的耐受性较低（P=0.009），且基线和疼痛后皮质醇水平较高（均 P<0.001）。在基线时，患者的交感神经张力较高（P=0.04），而在疼痛时，他们增加了副交感神经张力（P≤0.008）。综合数据分析，我们确定了两个具有不同心理生理学特征的“疼痛簇”。在以神经质、特质焦虑、基线皮质醇、疼痛敏感性和疼痛时副交感神经反应高为特征的簇中，患者的比例过高（均 P<0.03）。
在未来，FCP 人群中的这种划分可能有助于根据心理生理学特征进行个体化治疗。
