Wolfson Institute, Queen Mary University of London, UK.
Pain and anaesthetics research centre (PARC), St Bartholomew's Hospital, UK.
J Psychosom Res. 2021 Nov;150:110624. doi: 10.1016/j.jpsychores.2021.110624. Epub 2021 Sep 21.
Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are both complex conditions that are challenging to treat. This may be related to an incomplete understanding of their pathophysiology, itself obfuscated by their heterogeneity. The symptomatic overlap between them and their common comorbidity suggests a shared vulnerability, which might be explained by central sensitisation.
19 CFS cases, 19 FM cases and 20 age and sex matched healthy controls (HC) were recruited primarily from secondary care clinics in London. Those with other pain disorders, psychiatric diagnoses and those taking centrally acting or opiate medications were excluded. Participants were asked to abstain from alcohol and over the counter analgaesia 48 h prior to assessment by static and dynamic quantitative sensory tests, including measures of temporal summation (TS) and conditioned pain modulation (CPM).
CS, as defined by the presence of both enhanced TS and inefficient CPM, was present in 16 (84%) CFS cases, 18 (95%) FM cases, and none of the HC (p < 0.001). Pressure pain thresholds were lower in CFS (Median222kPaIQR 146-311; p = 0.04) and FM cases (Median 189 kPa; IQR 129-272; p = 0.003) compared to HC (Median 311 kPa; IQR 245-377). FM cases differed from HC in cold-induced (FM = 22.6 °C (15.3-27.7) vs HC = 14.2 °C (9.0-20.5); p = 0.01) and heat-induced (FM = 38.0 °C (35.2-44.0) vs HC = 45.3 °C (40.1-46.8); p = 0.03) pain thresholds, where CFS cases did not.
Central sensitisation may be a common endophenotype in chronic fatigue syndrome and fibromyalgia. Further research should address whether central sensitisation is a cause or effect of these disorders.
慢性疲劳综合征（CFS）和纤维肌痛（FM）都是难以治疗的复杂疾病。这可能与对其病理生理学的理解不完整有关，而病理生理学本身又因疾病异质性而变得复杂。它们之间存在症状重叠和共同的共病，提示存在共同的脆弱性，这可能可以用中枢敏化来解释。
19 例 CFS 患者、19 例 FM 患者和 20 例年龄和性别匹配的健康对照者（HC）主要从伦敦的二级保健诊所招募。排除有其他疼痛障碍、精神诊断和使用中枢作用或阿片类药物的患者。在评估前 48 小时，参与者被要求避免饮酒和非处方止痛药。参与者接受了静态和动态定量感觉测试，包括时间总和（TS）和条件性疼痛调制（CPM）的测量。
CS 的定义为同时存在增强的 TS 和 CPM 效率低下，16 例（84%）CFS 患者、18 例（95%）FM 患者符合 CS 标准，而健康对照者中没有符合标准的患者（p<0.001）。CFS（中位数 222kPa，IQR 146-311；p=0.04）和 FM 病例（中位数 189kPa，IQR 129-272；p=0.003）的压力疼痛阈值低于 HC（中位数 311kPa，IQR 245-377）。与 HC 相比，FM 病例在冷诱发（FM=22.6°C（15.3-27.7）与 HC=14.2°C（9.0-20.5）；p=0.01）和热诱发（FM=38.0°C（35.2-44.0）与 HC=45.3°C（40.1-46.8）；p=0.03）疼痛阈值方面存在差异，而 CFS 病例没有。
中枢敏化可能是慢性疲劳综合征和纤维肌痛的共同表型。进一步的研究应该探讨中枢敏化是这些疾病的原因还是结果。
