Montoro Casandra I, Duschek Stefan, de Guevara Cristina Muñóz Ladrón, Reyes Del Paso Gustavo A
*Department of Psychology, University of Jaén, Jaén, Spain.
UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
Pain Med. 2016 Dec;17(12):2256-2267. doi: 10.1093/pm/pnw082. Epub 2016 May 31.
This study analyzed the temporal dynamics of cerebral blood flow (CBF) modulations, during painful stimulation in fibromyalgia syndrome (FMS), using functional transcranial Doppler sonography.
Blood flow velocities were recorded bilaterally in the anterior (ACA) and middle (MCA) cerebral arteries of 24 FMS patients and 20 healthy individuals during exposure to painful pressure stimulation. Participants were presented with two stimulation blocks: a) fixed pressure (2.4 kg) and b) stimulation pressure, individually calibrated to produce equal subjective and moderate pain intensity in all participants.
A complex pattern of CBF modulations arose, comprising four main components: an anticipatory increase before stimulation onset, an early increase, a transient decrease to baseline or below, and a final increase. Group differences were observed in all components. The anticipatory component only arose in FMS patients, specifically in the ACA. Patients exhibited a greater early CBF increase under the fixed pressure condition, predominantly in the right ACA. A stronger CBF decrease after the early component was observed in patients during the equal pain condition, in the ACA and MCA. Significant associations were found between clinical pain severity and CBF responses in the MCA.
The results demonstrate that acute pain processing is associated with a complex pattern of CBF modulation, where FMS patients exhibited alterations in all phases of the response. The aberrances may be ascribed to psychophysiological phenomena, including central nervous nociceptive sensitization and protective-defensive reflex mechanisms. The anticipatory CBF response in patients may relate to various cognitive, emotional, and behavioral mechanisms involved in pain chronification.
本研究使用功能性经颅多普勒超声分析纤维肌痛综合征（FMS）患者在疼痛刺激期间脑血流（CBF）调节的时间动态变化。
在24例FMS患者和20名健康个体暴露于疼痛压力刺激期间，双侧记录前脑动脉（ACA）和中脑动脉（MCA）的血流速度。参与者接受两个刺激组：a）固定压力（2.4千克）和b）刺激压力，分别进行校准以在所有参与者中产生相等的主观中度疼痛强度。
出现了复杂的CBF调节模式，包括四个主要成分：刺激开始前的预期增加、早期增加、短暂降至基线或以下以及最终增加。在所有成分中均观察到组间差异。预期成分仅出现在FMS患者中，特别是在ACA中。在固定压力条件下，患者早期CBF增加更大，主要在右侧ACA。在同等疼痛条件下，患者在ACA和MCA中早期成分后CBF下降更强。在MCA中，临床疼痛严重程度与CBF反应之间存在显著关联。
结果表明，急性疼痛处理与复杂的CBF调节模式相关，其中FMS患者在反应的所有阶段均表现出改变。这些异常可能归因于心理生理现象，包括中枢神经伤害性致敏和保护性防御反射机制。患者的预期CBF反应可能与疼痛慢性化涉及的各种认知、情感和行为机制有关。
