de la Coba Pablo, Bruehl Stephen, Del Paso Gustavo A Reyes
Department of Psychology, University of Jaén, Jaén, Spain; †Institute of Biomedical Research of Lleida, Lleida, Spain.
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Pain Med. 2020 Dec 25;21(12):3479-3487. doi: 10.1093/pm/pnz346.
Fibromyalgia is a chronic pain syndrome characterized by central sensitization. A novel protocol based on slowly repeated evoked pain (SREP) appears to be a useful marker of pain sensitization in fibromyalgia patients. Whether SREP enhances diagnostic accuracy beyond key clinical symptoms that characterize fibromyalgia has not been examined.
Fifty fibromyalgia patients, 30 rheumatoid arthritis patients, and 50 healthy individuals were evaluated to assess clinical pain, as well as fatigue, insomnia, pain catastrophizing, and negative mood. The SREP protocol consisted of a series of nine low-intensity painful pressure stimuli of five seconds' duration with 30-second interstimulus intervals. SREP sensitization was indexed by increases in pain intensity ratings across stimuli.
SREP sensitization was observed in fibromyalgia but not in rheumatoid arthritis or healthy individuals. As expected, fibromyalgia patients exhibited a more negative psychosocial profile than did rheumatoid arthritis patients and healthy individuals. SREP was positively associated with clinical pain, fatigue, insomnia, and catastrophizing, but not with negative mood. SREP discriminated fibromyalgia cases from rheumatoid arthritis and healthy individuals even when current clinical pain was included in the analysis. Combining fatigue, insomnia, and SREP led to near perfect diagnostic accuracy (99%) in differentiating fibromyalgia from healthy individuals and 86.3% accuracy in discriminating fibromyalgia from rheumatoid arthritis.
These results provide further evidence of SREP as a marker of pain sensitization in fibromyalgia and suggest that it captures aspects of fibromyalgia not fully captured by clinical features. Combining SREP with assessment of clinical features could potentially improve fibromyalgia diagnosis.
纤维肌痛是一种以中枢敏化为特征的慢性疼痛综合征。一种基于缓慢重复诱发疼痛（SREP）的新方案似乎是纤维肌痛患者疼痛敏化的有用标志物。SREP是否能提高诊断准确性，超越纤维肌痛的关键临床症状，尚未得到研究。
对50名纤维肌痛患者、30名类风湿性关节炎患者和50名健康个体进行评估，以评估临床疼痛以及疲劳、失眠、疼痛灾难化和负面情绪。SREP方案包括一系列九个持续五秒的低强度疼痛压力刺激，刺激间隔为30秒。SREP敏化通过刺激间疼痛强度评分的增加来衡量。
在纤维肌痛患者中观察到SREP敏化，而在类风湿性关节炎患者或健康个体中未观察到。正如预期的那样，纤维肌痛患者比类风湿性关节炎患者和健康个体表现出更消极的心理社会特征。SREP与临床疼痛（）、疲劳、失眠和灾难化呈正相关，但与负面情绪无关。即使在分析中纳入当前临床疼痛，SREP也能将纤维肌痛病例与类风湿性关节炎患者和健康个体区分开来。结合疲劳、失眠和SREP在区分纤维肌痛与健康个体时诊断准确性接近完美（99%），在区分纤维肌痛与类风湿性关节炎时准确性为86.3%。
这些结果进一步证明SREP是纤维肌痛疼痛敏化的标志物，并表明它捕捉到了纤维肌痛临床特征未完全捕捉到的方面。将SREP与临床特征评估相结合可能会提高纤维肌痛的诊断水平。
