与健康对照组相比，压力和放松对慢性挥鞭伤和纤维肌痛患者中枢性疼痛调制的影响

Effects of Stress and Relaxation on Central Pain Modulation in Chronic Whiplash and Fibromyalgia Patients Compared to Healthy Controls.

作者信息

Coppieters Iris, Cagnie Barbara, Nijs Jo, van Oosterwijck Jessica, Danneels Lieven, De Pauw Robby, Meeus Mira

机构信息

Pain in Motion Research Group (www.paininmotion.be); Department of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.

Pain in Motion Research Group (www.paininmotion.be); Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium.

出版信息

Pain Physician. 2016 Mar;19(3):119-30.

PMID:27008285

Abstract

BACKGROUND

Compelling evidence has demonstrated that impaired central pain modulation contributes to persistent pain in patients with chronic whiplash associated disorders (WAD) and fibromyalgia (FM). However, there is limited research concerning the influence of stress and relaxation on central pain modulation in patients with chronic WAD and FM.

OBJECTIVES

The present study aims to investigate the effects of acute cognitive stress and relaxation on central pain modulation in chronic WAD and FM patients compared to healthy individuals.

STUDY DESIGN

A randomized crossover design was employed.

SETTING

The present study took place at the University of Brussels, the University Hospital Brussels, and the University of Antwerp.

METHODS

Fifty-nine participants (16 chronic WAD patients, 21 FM, 22 pain-free controls) were enrolled and subjected to various pain measurements. Temporal summation (TS) of pain and conditioned pain modulation (CPM) were evaluated. Subsequently, participants were randomly allocated to either a group that received progressive relaxation therapy or a group that performed a battery of cognitive tests (= cognitive stressor). Afterwards, all pain measurements were repeated. One week later participant groups were switched.

RESULTS

A significant difference was found between the groups in the change in TS in response to relaxation (P = 0.008) and cognitive stress (P = 0.003). TS decreased in response to relaxation and cognitive stress in chronic WAD patients and controls. In contrast, TS increased after both interventions in FM patients. CPM efficacy decreased in all 3 groups in response to relaxation (P = 0.002) and cognitive stress (P = 0.001).

LIMITATIONS

The obtained results only apply for a single session of muscle relaxation therapy and cognitive stress, whereby no conclusions can be made for effects on pain perception and modulation of chronic cognitive stress and long-term relaxation therapies.

CONCLUSIONS

A single relaxation session as well as cognitive stress may have negative acute effects on pain modulation in patients with FM, while cognitive stress and relaxation did not worsen bottom-up sensitization in chronic WAD patients and healthy persons. However, endogenous pain inhibition, assessed using a CPM paradigm, worsened in chronic WAD and FM patients, as well as in healthy people following both interventions.

摘要

背景

有力证据表明，中枢性疼痛调制受损会导致慢性挥鞭样损伤相关疾病（WAD）和纤维肌痛（FM）患者出现持续性疼痛。然而，关于压力和放松对慢性WAD和FM患者中枢性疼痛调制的影响的研究有限。

目的

本研究旨在调查与健康个体相比，急性认知应激和放松对慢性WAD和FM患者中枢性疼痛调制的影响。

研究设计

采用随机交叉设计。

研究地点

本研究在布鲁塞尔大学、布鲁塞尔大学医院和安特卫普大学进行。

方法

招募了59名参与者（16名慢性WAD患者、21名FM患者、22名无疼痛对照者），并对他们进行了各种疼痛测量。评估了疼痛的时间总和（TS）和条件性疼痛调制（CPM）。随后，参与者被随机分配到接受渐进性放松疗法的组或进行一系列认知测试的组（=认知应激源）。之后，重复所有疼痛测量。一周后，参与者组进行了交换。