Wodehouse Theresa, Poply Kavita, Ramaswamy Shankar, Snidvongs Saowarat, Bourke Julius, Tahir Hasan, Ullrich Kristin, Mehta Vivek
Pain and Anaesthesia Research Centre, Barts Health NHS Trust, London, UK.
Centre for Psychiatry, Barts Health NHS Trust, London, UK.
Br J Pain. 2018 Nov;12(4):250-256. doi: 10.1177/2049463718776336. Epub 2018 May 15.
Fibromyalgia is a chronic musculoskeletal pain condition that is often associated with sleep disturbances and fatigue. The pathophysiology of fibromyalgia is not understood, but indirect evidence suggests a central dysfunction of the nociceptive modulating system. The aim of this study was to evaluate whether quantitative sensory testing detects a change in pain thresholds in fibromyalgia patient receiving pregabalin treatment.
A total of 25 patients were recruited for the study and received routine pregabalin, but only 14 patients completed the treatment. Assessment of pressure pain thresholds and changes in conditioned pain modulation using ischaemic pain as a conditioning stimulus were measured at baseline and every 4 weeks for 12 weeks. Fibromyalgia impact questionnaire, PainDETECT and SF-12 were also completed.
Patients with fibromyalgia demonstrated a less-efficient conditioned pain modulation at baseline. An efficient conditioned pain modulation was observed at 1 month and this was maintained until the final visit. Pressure pain thresholds (PPTs) showed a significant improvement from baseline. Patients also reported a similar magnitude of improvements in PainDETECT, fibromyalgia impact questionnaire (FIQ) and its impact on daily life and change in outcome for SF-12.
This pilot study reports an increase in PPTs and improved conditioned pain modulation response after commencing pregabalin, which was maintained at 12 weeks, and this was supported by positive pain scores. Pregabalin is a licenced treatment for fibromyalgia in Europe, and its response to central sensitisation, particularly 'dynamic responses', has not been reported. We conclude that pregabalin has the potential to reduce peripheral and central sensitisation in patients with fibromyalgia, as measured using quantitative sensory testing.
纤维肌痛是一种慢性肌肉骨骼疼痛疾病，常伴有睡眠障碍和疲劳。纤维肌痛的病理生理学尚不清楚，但间接证据表明伤害性感受调节系统存在中枢功能障碍。本研究的目的是评估定量感觉测试是否能检测到接受普瑞巴林治疗的纤维肌痛患者疼痛阈值的变化。
共招募25名患者参与本研究并接受常规普瑞巴林治疗，但只有14名患者完成了治疗。在基线时以及每4周进行一次，共持续12周，测量压力疼痛阈值，并使用缺血性疼痛作为条件刺激来评估条件性疼痛调制的变化。还完成了纤维肌痛影响问卷、疼痛检测量表和SF-12。
纤维肌痛患者在基线时表现出效率较低的条件性疼痛调制。在1个月时观察到有效的条件性疼痛调制，并且一直维持到最后一次随访。压力疼痛阈值较基线有显著改善。患者在疼痛检测量表、纤维肌痛影响问卷及其对日常生活的影响以及SF-12的结果变化方面也报告了类似程度的改善。
这项初步研究报告称，开始使用普瑞巴林后压力疼痛阈值升高，条件性疼痛调制反应改善，这种情况在12周时得以维持，并且得到了积极疼痛评分的支持。普瑞巴林在欧洲是一种获批用于治疗纤维肌痛的药物，其对中枢敏化的反应，特别是“动态反应”，此前尚未见报道。我们得出结论，使用定量感觉测试测量，普瑞巴林有可能减轻纤维肌痛患者的外周和中枢敏化。
