Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, United States.
Pain. 2023 Feb 1;164(2):e91-e102. doi: 10.1097/j.pain.0000000000002696. Epub 2022 May 19.
Multisensory sensitivity (MSS) to nonpainful stimuli has been identified as a risk factor for the presence of coexisting chronic pain conditions. However, it remains unclear whether MSS can differentiate pain phenotypes involving different levels of central sensitivity. Both pain-free and those with chronic pain, particularly fibromyalgia (FM), migraine, or low back pain (LBP) were recruited, with pain comorbidities assessed. MSS was highest in FM, followed by migraine, then LBP, and lowest in pain-free individuals (adjusted between condition Cohen d = 0.32-1.2, P ≤ 0.0007). However, when secondly grouping patients by the total number of pain comorbidities reported, those with a single pain condition (but not FM) did not have significantly elevated MSS vs pain-free individuals (adj d= 0.17, P = 0.18). Elevated MSS scores produced increased odds of having 2 or more pain comorbidities; OR [95% CI] =2.0 [1.15, 3.42], without, and 5.6 [2.74, 11.28], with FM ( P ≤ 0.0001). Furthermore, those with low MSS levels were 55% to 87% less likely to have ≥ 2 pain comorbidities with or without FM (OR 0.45 [0.22, 0.88]-0.13 [0.05, 0.39]; P ≤ 0.0001). Our findings support that MSS can differentiate between pain phenotypes with different degrees of expected central mechanism involvement and also serve as a risk and resilience marker for total coexisting chronic pain conditions. This supports the use of MSS as a marker of heightened central nervous system processing and thus may serve as a clinically feasible assessment to better profile pain phenotypes with the goal of improving personalized treatment.
多感觉敏感性（MSS）对非疼痛刺激的反应已被确定为共存慢性疼痛状况存在的危险因素。然而，目前尚不清楚 MSS 是否可以区分涉及不同程度中枢敏感性的疼痛表型。招募了无痛和有慢性疼痛的人，包括纤维肌痛（FM）、偏头痛或下腰痛（LBP），并评估了疼痛合并症。FM 患者的 MSS 最高，偏头痛患者次之，LBP 患者再次之，无痛患者最低（调整后条件间 Cohen d = 0.32-1.2，P ≤ 0.0007）。然而，当根据报告的疼痛合并症总数再次对患者进行分组时，只有一种疼痛状况（而非 FM）的患者的 MSS 与无痛患者相比没有显著升高（调整后 d= 0.17，P = 0.18）。升高的 MSS 评分增加了有 2 种或更多疼痛合并症的可能性；OR [95%CI] =2.0 [1.15, 3.42]，无 FM；和 5.6 [2.74, 11.28]，有 FM（P ≤ 0.0001）。此外，MSS 水平较低的患者发生≥2 种疼痛合并症的可能性降低了 55%至 87%，无论有无 FM（OR 0.45 [0.22, 0.88]-0.13 [0.05, 0.39]；P ≤ 0.0001）。我们的研究结果支持 MSS 可以区分不同程度预期中枢机制参与的疼痛表型，并且还可以作为总共存慢性疼痛状况的风险和恢复力标志物。这支持将 MSS 用作中枢神经系统处理增强的标志物，从而可以作为一种可行的临床评估方法，更好地分析疼痛表型，从而实现个性化治疗。
