Goesling Jenna, Brummett Chad M, Meraj Taha S, Moser Stephanie E, Hassett Afton L, Ditre Joseph W
Department of Anesthesiology, University of Michigan, Ann Arbor MI, University of Michigan, Back & Pain Center, Burlington Building 1, Suite 310, 325 E. Eisenhower Parkway, Ann Arbor, Michigan, USA.
Medical School, University of Michigan, Ann Arbor, MI.
Pain Med. 2015 Jul;16(7):1433-42. doi: 10.1111/pme.12747. Epub 2015 Mar 20.
As smoking impacts physiological pathways in the central nervous system, it is important to consider the association between smoking and fibromyalgia, a pain condition caused predominantly by central nervous system dysfunction. The objectives were to assess the prevalence of current smoking among treatment-seeking chronic pain patients with (FM+) and without (FM-) a fibromyalgia-like phenotype; test the individual and combined influence of smoking and fibromyalgia on pain severity and interference; and examine depression as a mediator of these processes.
Questionnaire data from 1566 patients evaluated for a range of conditions at an outpatient pain clinic were used. The 2011 Survey Criteria for Fibromyalgia were used to assess the presence of symptoms associated with fibromyalgia.
Current smoking was reported by 38.7% of FM+ patients compared to 24.7% of FM- patients. FM+ smokers reported higher pain and greater interference compared to FM+ nonsmokers, FM- smokers, and FM- nonsmokers. There was no interaction between smoking and fibromyalgia. Significant indirect effects of fibromyalgia and smoking via greater depression were observed for pain severity and interference.
Current smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge.
由于吸烟会影响中枢神经系统的生理途径，因此有必要考虑吸烟与纤维肌痛之间的关联，纤维肌痛是一种主要由中枢神经系统功能障碍引起的疼痛病症。目的是评估有（FM+）和无（FM-）纤维肌痛样表型的寻求治疗的慢性疼痛患者中当前吸烟的患病率；测试吸烟和纤维肌痛对疼痛严重程度和干扰的个体及综合影响；并检验抑郁作为这些过程的中介因素。
使用了来自1566名在门诊疼痛诊所接受多种病症评估的患者的问卷数据。采用2011年纤维肌痛调查标准来评估与纤维肌痛相关症状的存在情况。
报告显示，38.7%的FM+患者当前吸烟，而FM-患者为24.7%。与FM+非吸烟者、FM-吸烟者和FM-非吸烟者相比，FM+吸烟者报告的疼痛程度更高，干扰更大。吸烟与纤维肌痛之间没有相互作用。观察到纤维肌痛和吸烟通过加重抑郁对疼痛严重程度和干扰产生显著的间接影响。
当前吸烟和纤维肌痛阳性状态与慢性疼痛患者中更严重的疼痛和功能损害相关，这可能是抑郁作用的结果。尽管FM+吸烟者报告的临床症状最负面（即疼痛程度高、干扰大），但吸烟似乎与FM+患者的疼痛或功能没有独特的关联，而是具有累加效应。FM+患者中38.7%的吸烟率很高，这表明FM+吸烟者带来了重大的临床挑战。
