Helme R D, Littlejohn G O, Weinstein C
Department of Medicine, Prince Henry's Hospital, Melbourne, Victoria.
Clin Exp Neurol. 1987;23:91-4.
Chronic rheumatic pain syndromes such as the fibrositis syndrome, 'whiplash' syndrome, low back pain syndrome and regional pain syndrome are common clinical disorders of unknown cause. The presence of tender points in predictable anatomical locations is essential to their diagnosis. Exaggerated dermatographia or flare response to mechanical stimulation is also a commonly observed physical finding. Dermatographia is thought to be a local axon reflex mediated phenomenon, and, as such, is a component of the neurogenic inflammatory response. Because neurogenic inflammation may be mediated by polymodal nociceptors we examined the flare response to topical capsaicin, a chemical method of stimulating local axon reflexes, in 12 patients with chronic rheumatic pain syndromes and in 10 controls. There was a significant correlation (rs = 0.61; p less than 0.01) between the area of flare induced by mechanical stimulation and the area of flare induced by chemical stimulation for all subjects. Patients with chronic rheumatic pain syndromes had a lower threshold for capsaicin-induced flare responses compared with controls. They also had larger flares at capsaicin concentrations of 0.02 and 0.033 mg/mL (p less than 0.05) applied as 20 microL aliquots over 30 minutes. It is concluded that neurogenic flare responses are increased in patients with chronic rheumatic pain syndromes.
慢性风湿性疼痛综合征，如纤维织炎综合征、“挥鞭样损伤”综合征、下腰痛综合征和局部疼痛综合征，是常见的病因不明的临床病症。在可预测的解剖位置存在压痛点对其诊断至关重要。对机械刺激的皮肤划痕症或潮红反应增强也是常见的体格检查发现。皮肤划痕症被认为是一种局部轴突反射介导的现象，因此是神经源性炎症反应的一个组成部分。由于神经源性炎症可能由多模式伤害感受器介导，我们对12例慢性风湿性疼痛综合征患者和10例对照者进行了研究，观察了对辣椒素局部应用的潮红反应，这是一种刺激局部轴突反射的化学方法。对所有受试者而言，机械刺激诱发的潮红面积与化学刺激诱发的潮红面积之间存在显著相关性（rs = 0.61；p小于0.01）。与对照组相比，慢性风湿性疼痛综合征患者对辣椒素诱发的潮红反应阈值较低。在30分钟内以20微升等分试样形式应用浓度为0.02和0.033毫克/毫升的辣椒素时，他们的潮红也更大（p小于0.05）。得出的结论是，慢性风湿性疼痛综合征患者的神经源性潮红反应增强。
