Physiotherapy Unit, Nª Sª del Prado Hospital, Talavera de la Reina, Spain; University of San Jorge, Zaragoza, Spain; Toledo Physiotherapy Research Group (GIFTO).
University of Castilla-La Mancha, Faculty of Physiotherapy and Nursing, Toledo, Spain; Toledo Physiotherapy Research Group (GIFTO).
Pain Physician. 2020 Jul;23(4):E353-E362.
Fibromyalgia (FM) syndrome is characterized by widespread pain, fatigue, and generalized increased pain sensitivity. Appropriate and simple pain models are methods employed to assess pain mechanisms that can potentially lead to improved treatments. Pressure pain thresholds (PPTs) or mapping the referred pain area produced by pressure stimulation at suprathreshold intensities are used to assess pain mechanisms. The optimal suprathreshold stimulation intensity to elicit referred pain with minimal discomfort for patients with FM has yet to be determined.
The aim of this study was to compare the area and intensity of pressure-induced referred pain in patients with FM as elicited by systematic increases in PPTs, compared with controls.
Observational, crossed-section study.
Research laboratory.
Twenty-six patients with FM and 26 healthy controls, age- and gender-matched, were included. Suprathreshold stimulation was applied to the infraspinatus muscle of the dominant side at 4 different intensities (PPT +20%, +30%, +40%, and +50%), after which referred pain was evaluated by measuring the area of pain in pixels using a digital body chart and its intensity on a Visual Analog Scale. Factors related to anxiety condition, pain catastrophizing, depression, and quality of life were recorded.
The referred pain areas were larger in the FM group compared with healthy individuals at 120% (P = 0.024), 130% (P = 0.001), 140% (P = 0.001), and 150% (P = 0.001) PPT, however, within the FM group no differences were found between the intensity of suprathreshold stimulation and the size of the referred pain areas (P = 0.135) or pain intensity (P > 0.05). There was a positive correlation between the size of referred pain areas and pain catastrophizing in the FM group (r = 0.457, P = 0.032).
This study presents some limitations, among which is the variability found in the referred pain areas.
These findings show that referred pain induced by applying a suprathreshold pressure of 120% PPT can be a useful biomarker to assess sensitized pain mechanisms in patients suffering from FM.
Referred pain, pain sensitivity, fibromyalgia, central sensitization, suprathreshold, pressure pain threshold, biomarker, facilitated pain mechanisms.
纤维肌痛（FM）综合征的特征是广泛疼痛、疲劳和全身性疼痛敏感性增加。适当且简单的疼痛模型是评估潜在治疗方法的疼痛机制的方法。压力疼痛阈值（PPT）或在超阈值强度下进行压力刺激以绘制压力引起的牵涉痛区域，用于评估疼痛机制。用于诱发纤维肌痛患者的牵涉痛而不会引起不适的最佳超阈值刺激强度尚未确定。
本研究旨在比较纤维肌痛患者和对照组通过系统增加 PPT 诱发的压力诱导的牵涉痛区域和强度。
观察性、交叉研究。
研究实验室。
纳入 26 名纤维肌痛患者和 26 名年龄和性别匹配的健康对照组。在优势侧的肩胛下肌施加 4 种不同强度的超阈值刺激（PPT +20%、+30%、+40%和+50%），然后使用数字人体图表测量疼痛区域的像素数和视觉模拟量表评估牵涉痛强度。记录与焦虑状况、疼痛灾难化、抑郁和生活质量相关的因素。
与健康个体相比，FM 组在 120%（P = 0.024）、130%（P = 0.001）、140%（P = 0.001）和 150%（P = 0.001）PPT 时的牵涉痛区域更大，然而，在 FM 组中，超阈值刺激的强度与牵涉痛区域的大小（P = 0.135）或疼痛强度（P > 0.05）之间没有差异。在 FM 组中，牵涉痛区域的大小与疼痛灾难化之间存在正相关（r = 0.457，P = 0.032）。
本研究存在一些局限性，其中包括牵涉痛区域的变异性。
这些发现表明，施加 120% PPT 超阈值压力引起的牵涉痛可以作为评估纤维肌痛患者敏感化疼痛机制的有用生物标志物。
牵涉痛、疼痛敏感性、纤维肌痛、中枢敏化、超阈值、压力疼痛阈值、生物标志物、易化疼痛机制。
