Thabit Mohamed N, Ezat Ahmad, Ismael Mohamed A, Hadad Saber
Department of Neurology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
Department of Rheumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
J Clin Neurol. 2021 Jan;17(1):121-127. doi: 10.3988/jcn.2021.17.1.121.
Abnormal excitability of the central nervous system, both spinal and supraspinal, has previously been described as a pathophysiological plastic mechanism for chronic pain syndromes. Primary fibromyalgia (FM) as one extreme of this spectrum of diseases. This case-control study aimed to determine the changes in the spinal excitability by investigating the Hoffman reflex (H-reflex) in patients with FM.
Thirty-eight patients with FM and 30 healthy controls participated in this case-control study. We measured the H-reflex bilaterally in the upper limbs (flexor carpi radialis) and the lower limbs (gastrocnemius and soleus). Moreover, pain-related variables were measured, including pain severity (using a visual analogue scale), pain duration, Widespread Pain Index, and the score on the Symptom Severity Scale. Various psychiatric comorbidities and quality-of-life parameters were measured for each patient, including scores on the Hamilton Depression Rating Scale, Taylor's Manifest Anxiety Scale, and the Revised Fibromyalgia Impact Questionnaire.
A significant increase in the ratio of the maximum baseline-to-peak amplitudes of H and M waves (H/M) but not in the H-wave minimum latency was found in patients with FM compared with healthy controls. There were no significant correlations between this ratio in both muscles and the various pain-related measures, psychiatric comorbidity, and quality of life in patients with FM. Patients with FM suffered more depression and anxiety than did the controls.
We found increased spinal excitability in patients with FM, which was not confined to the site of maximum pain. This information may help in the diagnosis of FM and supports the hypothesis of central sensitization.
先前已将中枢神经系统（包括脊髓和脊髓以上部位）的异常兴奋性描述为慢性疼痛综合征的一种病理生理可塑性机制。原发性纤维肌痛（FM）是这类疾病谱中的一个极端情况。本病例对照研究旨在通过调查FM患者的霍夫曼反射（H反射）来确定脊髓兴奋性的变化。
38例FM患者和30名健康对照者参与了本病例对照研究。我们双侧测量了上肢（桡侧腕屈肌）和下肢（腓肠肌和比目鱼肌）的H反射。此外，还测量了与疼痛相关的变量，包括疼痛严重程度（使用视觉模拟量表）、疼痛持续时间、广泛性疼痛指数和症状严重程度量表得分。对每位患者测量了各种精神共病情况和生活质量参数，包括汉密尔顿抑郁量表得分、泰勒显性焦虑量表得分和修订的纤维肌痛影响问卷得分。
与健康对照者相比，FM患者的H波和M波最大基线至峰值振幅之比（H/M）显著增加，但H波最小潜伏期无显著变化。FM患者双侧肌肉的该比值与各种疼痛相关指标、精神共病情况和生活质量之间均无显著相关性。FM患者比对照组更容易出现抑郁和焦虑。
我们发现FM患者的脊髓兴奋性增加，且不限于疼痛最严重的部位。这一信息可能有助于FM的诊断，并支持中枢敏化假说。
