Section of Rheumatology, Institute of Infection and Immunity, Cardiff University School of Medicine, Tenovus Building, Heath Park, Cardiff CF14 4XN, UK.
Nat Rev Rheumatol. 2015 Sep;11(9):513-20. doi: 10.1038/nrrheum.2015.56. Epub 2015 Apr 28.
Fibromyalgia is a common cause of chronic widespread pain, characterized by reduced pressure pain thresholds with hyperalgesia and allodynia. In addition to pain, common symptoms include nonrestorative sleep, fatigue, cognitive dysfunction, stiffness and mood disturbances. The latest research indicates that the dominant pathophysiology in fibromyalgia is abnormal pain processing and central sensitization. Neuroimaging studies have shown that patients with fibromyalgia have similar neural activation to healthy age-matched and gender-matched individuals; however, they have a lower pressure-pain threshold. Polysomnography data has demonstrated that these patients have reduced short-wave sleep and abnormal α-rhythms, suggestive of wakefulness during non-REM (rapid eye movement) sleep. Sleep deprivation in healthy individuals can cause symptoms of fibromyalgia, including myalgia, tenderness and fatigue, suggesting that sleep dysfunction might be not only a consequence of pain, but also pathogenic. Epidemiological studies indicate that poor sleep quality is a risk factor for the development of chronic widespread pain among an otherwise healthy population. Mechanistically, sleep deprivation impairs descending pain-inhibition pathways that are important in controlling and coping with pain. Clinical trials of pharmacological and nonpharmacological therapies have shown that improving sleep quality can reduce pain and fatigue, further supporting the hypothesis that sleep dysfunction is a pathogenic stimulus of fibromyalgia.
纤维肌痛是一种常见的慢性广泛性疼痛病因，其特征是压力痛觉阈值降低，出现痛觉过敏和感觉异常。除了疼痛之外，常见的症状还包括睡眠质量不佳、疲劳、认知功能障碍、僵硬和情绪紊乱。最新的研究表明，纤维肌痛的主要病理生理学机制是异常的疼痛处理和中枢敏化。神经影像学研究表明，纤维肌痛患者与健康的年龄和性别匹配的个体具有相似的神经激活；然而，他们的压力疼痛阈值较低。多导睡眠图数据表明，这些患者的短睡眠波减少，α 节律异常，提示非快速眼动（REM）睡眠期间存在清醒状态。健康个体的睡眠剥夺会导致纤维肌痛的症状，包括肌痛、压痛和疲劳，这表明睡眠功能障碍不仅是疼痛的后果，而且可能是病因。流行病学研究表明，睡眠质量差是健康人群中慢性广泛性疼痛发展的一个风险因素。从机制上讲，睡眠剥夺会损害对疼痛进行控制和应对的下行性疼痛抑制通路。药物和非药物治疗的临床试验表明，改善睡眠质量可以减轻疼痛和疲劳，进一步支持睡眠功能障碍是纤维肌痛的致病刺激的假说。
