aInstitute of Surgical Pathology, "G D'Annunzio" University of Chieti, ItalybFibromyalgia Center, Department of Medicine and Science of Aging, "G D'Annunzio" University of Chieti, Chieti, ItalycCenter of Sciences of Aging and Translational Medicine, CeSI-MeT, Chieti, ItalydDivision of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USADepartments of eNeurology andfObstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
Pain. 2017 Oct;158(10):1925-1937. doi: 10.1097/j.pain.0000000000000992.
Fibromyalgia syndrome (FMS) is a central sensitization syndrome; however, peripheral pain sources potentially exacerbate its symptoms of chronic diffuse musculoskeletal pain and hyperalgesia. This prospective study evaluated visceral pain as a possible triggering factor for FMS pain and hyperalgesia in comorbid patients. Women with (1) FMS + irritable bowel syndrome (IBS); (2) FMS + primary dysmenorrhea (Dys); (3) FMS + Dys secondary to endometriosis (Endo); (4) FMS + colon diverticulosis (Div) were compared with FMS-only women, for fibromyalgia pain (number and intensity of episodes and analgesic consumption) over comparable periods and for somatic hyperalgesia (electrical and pressure pain thresholds) in painful (tender points) and control areas (trapezius, deltoid, quadriceps muscles, and overlying subcutis and skin). In comorbid subgroups, FMS symptoms were also reassessed after treatment of the visceral condition or no treatment. All comorbid groups vs FMS-only had significantly higher FMS pain (number/intensity of episodes and analgesic consumption) and hyperalgesia in deep somatic tissues (subcutis and muscle) at all sites (0.05 < P < 0.0001). Visceral pain (number of IBS days, painful menstrual cycles, and abdominal pain episodes from diverticulitis) correlated directly with all parameters of FMS pain and inversely with muscle pain thresholds at all sites (0.03 < P < 0.0001). Fibromyalgia syndrome pain and hyperalgesia in all tissues and all sites significantly decreased in patients after visceral comorbidity treatment (dietary for 6 months [IBS], hormonal for 6 months [dysmenorrhea], laser [endometriosis], and surgery [diverticulosis]) (0.05 < P < 0.0001) vs no change in untreated patients. Visceral pain enhances FMS symptoms, probably augmenting the level of central sensitization typical of the syndrome. Systematic assessment and treatment of visceral pain comorbidities should be a part of FMS management strategy.
纤维肌痛综合征（FMS）是一种中枢敏化综合征；然而，外周疼痛源可能会加重其慢性弥漫性肌肉骨骼疼痛和痛觉过敏的症状。这项前瞻性研究评估了内脏疼痛作为 FMS 疼痛和痛觉过敏的可能触发因素，这些疼痛和痛觉过敏发生在合并症患者中。患有（1）纤维肌痛综合征+肠易激综合征（IBS）；（2）纤维肌痛综合征+原发性痛经（Dys）；（3）纤维肌痛综合征+子宫内膜异位症引起的痛经（Endo）；（4）纤维肌痛综合征+结肠憩室病（Div）的女性与单纯纤维肌痛综合征女性进行比较，比较了可比时间段内的纤维肌痛疼痛（发作次数和强度以及镇痛药消耗）以及躯体痛觉过敏（电和压痛阈值）在疼痛（痛点）和对照区域（斜方肌、三角肌、股四头肌以及覆盖的皮下组织和皮肤）。在合并症亚组中，还在治疗内脏疾病或不治疗后重新评估了纤维肌痛综合征的症状。与单纯纤维肌痛综合征女性相比，所有合并症组的纤维肌痛综合征疼痛（发作次数/强度和镇痛药消耗）和深部躯体组织（皮下组织和肌肉）的痛觉过敏更高（0.05<P<0.0001）。内脏疼痛（IBS 天数、疼痛性月经周期以及憩室炎引起的腹痛发作）与纤维肌痛综合征疼痛的所有参数直接相关，与所有部位的肌肉疼痛阈值呈负相关（0.03<P<0.0001）。在接受内脏合并症治疗（6 个月饮食治疗[IBS]、6 个月激素治疗[痛经]、激光治疗[子宫内膜异位症]和手术治疗[憩室病]）的患者中，所有组织和所有部位的纤维肌痛综合征疼痛和痛觉过敏均显著降低（0.05<P<0.0001），而未接受治疗的患者则无变化。内脏疼痛会加重纤维肌痛综合征的症状，可能会增强该综合征典型的中枢敏化水平。系统评估和治疗内脏疼痛合并症应成为纤维肌痛综合征管理策略的一部分。
