Leone Caterina Maria, Celletti Claudia, Gaudiano Gianfranco, Puglisi Paola Anna, Fasolino Alessandra, Cruccu Giorgio, Camerota Filippo, Truini Andrea
Department of Human Neuroscience, Sapienza University, Rome, Italy.
Department of Physical medicine and Rehabilitation, Sapienza University, Rome, Italy.
Pain Med. 2020 Sep 1;21(9):1929-1935. doi: 10.1093/pm/pnaa038.
Although pain is a common complication of the hypermobile type of Ehlers-Danlos syndrome, its underlying mechanisms are still an issue of controversy. In this psychophysical study, we aimed at testing small-fiber function and the endogenous pain inhibitory control in patients with pain due to Ehlers-Danlos syndrome.
In 22 patients with pain due to Ehlers-Danlos syndrome and 22 healthy participants, matched for age and sex, we tested small-fiber function using quantitative sensory testing and the endogenous pain inhibitory control using the conditioned pain modulation (CPM) protocol. As quantitative sensory testing methods, we included thermal pain and mechanical pain thresholds and the wind-up ratio. The CPM protocol consisted of two heat painful stimuli, that is, a test stimulus and a conditioning stimulus.
All patients complained of widespread pain. Quantitative sensory testing revealed no small-fiber deficit; in the area of maximum pain, we found an increased wind-up ratio. Whereas in the healthy participants the CPM protocol showed that the test stimulus rating was significantly reduced during conditioning, in patients with pain due to hEDS, the test stimulus rating increased during conditioning.
Our psychophysical study showing that patients with pain due to hEDS have an increased wind-up ratio in the area of maximum pain and abnormal CPM protocol suggests that in this condition, pain is associated with central sensitization, possibly due to deficit of the endogenous pain inhibitory control. These data might be relevant to pharmacological treatment.
尽管疼痛是活动度过高型埃勒斯-当洛综合征常见的并发症，但其潜在机制仍存在争议。在这项心理物理学研究中，我们旨在测试埃勒斯-当洛综合征所致疼痛患者的小纤维功能和内源性疼痛抑制控制。
我们选取了22例埃勒斯-当洛综合征所致疼痛患者和22名年龄及性别匹配的健康参与者，使用定量感觉测试来检测小纤维功能，并使用条件性疼痛调制（CPM）方案来检测内源性疼痛抑制控制。作为定量感觉测试方法，我们纳入了热痛和机械痛阈值以及累积比率。CPM方案包括两种热痛刺激，即测试刺激和条件刺激。
所有患者均主诉有广泛疼痛。定量感觉测试未发现小纤维功能缺陷；在疼痛最严重的区域，我们发现累积比率增加。健康参与者的CPM方案显示，在条件刺激期间测试刺激评分显著降低，而在活动度过高型埃勒斯-当洛综合征所致疼痛患者中，测试刺激评分在条件刺激期间增加。
我们的心理物理学研究表明，活动度过高型埃勒斯-当洛综合征所致疼痛患者在疼痛最严重区域的累积比率增加，且CPM方案异常，这表明在这种情况下，疼痛与中枢敏化有关，可能是由于内源性疼痛抑制控制不足。这些数据可能与药物治疗相关。
