Arthritis Res Ther. 2013 Sep 23;15(5):R130. doi: 10.1186/ar4310.
The aim of this study was to investigate vulnerability and long-term influence of traumatic stress caused by the Great East Japan Disaster which occurred on March 11, 2011, in patients with fibromyalgia, which is a chronic pain syndrome probably involving central sensitization.
A total of 60 female patients with fibromyalgia were compared with female patients with rheumatoid arthritis (RA, n = 23) as another chronic pain disease, and with female healthy controls (HC, n = 26) in the observational study. To evaluate responses to traumatic stress, the scores of Impact of Event Scale-Revised (IES-R) were assessed one month after the disaster and every six months until 19 months after the disaster. We also evaluated levels of depression during the study period. To know the score of IES-R of patients with fibromyalgia during usual living, we assessed IES-R in another population of fibromyalgia patients without exposure to a great disaster.
The mean score of IES-R one month after the disaster in the fibromyalgia group (24.6 [SD 18.9]) was significantly higher than that of RA group (13.4 [SD 14.5]) or HC group (9.1 [9.2]) (F = 9.96, p < 0.0001). However, the mean score of IES-R in fibromyalgia patients without exposure to a great disaster was (20.3 [SD 18.7]), which was almost the same value as the fibromyalgia group seven months after the disaster (20.2 [SD 19.5]). Repeated measures analysis of variance showed significant effect of time course in the depression-related symptoms (F = 6.68, P = 0.001), and a post-hoc test revealed that the number of depression-related symptoms one month before the disaster was significantly different from other time points until 19 months after the disaster, respectively.
Although response to acute stress induced by the great earthquake was likely to be settled within seven months after the disaster, depression-related symptoms have been increasing for more than one year after the disaster, despite exclusion of patients with major depression at baseline. This long-lasting worsening of depression-related symptoms may have been in response to chronic stress induced by the fear of radiation due to the nuclear power disaster. These findings suggest that patients with fibromyalgia are vulnerable to chronic stress rather than acute stress.
本研究旨在探讨创伤后应激对纤维肌痛患者的脆弱性和长期影响，这种创伤后应激是由 2011 年 3 月 11 日发生的东日本大地震引起的。纤维肌痛是一种慢性疼痛综合征，可能涉及中枢敏化。
在这项观察性研究中，我们将 60 名纤维肌痛女性患者与类风湿关节炎（RA）女性患者（n=23）和健康女性对照组（HC）（n=26）进行了比较。为了评估创伤后应激反应，在灾难发生一个月后和灾难发生后 19 个月内，我们使用修订后的事件影响量表（IES-R）的评分来评估。我们还在研究期间评估了抑郁水平。为了了解纤维肌痛患者在正常生活中的 IES-R 评分，我们评估了另一组未暴露于大地震的纤维肌痛患者的 IES-R。
纤维肌痛组在灾难发生一个月后的 IES-R 平均评分（24.6[18.9]）明显高于 RA 组（13.4[14.5]）或 HC 组（9.1[9.2]）（F=9.96，p<0.0001）。然而，未暴露于大地震的纤维肌痛患者的 IES-R 平均评分（20.3[18.7]）与灾难发生七个月后的纤维肌痛组几乎相同（20.2[19.5]）。重复测量方差分析显示，抑郁相关症状的时间进程有显著影响（F=6.68，P=0.001），事后检验显示，灾难前一个月的抑郁相关症状数量与其他时间点分别有显著差异，直到灾难发生后 19 个月。
尽管大地震引起的急性应激反应可能在灾难发生后七个月内得到解决，但在排除基线时患有重度抑郁症的患者后，抑郁相关症状仍在灾难发生后一年多的时间内持续加重。这种抑郁相关症状的长期恶化可能是由于对核灾难引起的辐射恐惧而产生的慢性应激。这些发现表明，纤维肌痛患者易受慢性应激而不是急性应激的影响。
