VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Camilo Jose Cela University, Villanueva de la Cañada, Madrid, Spain.
Department of Physiotherapy, Faculty of Health, Camilo José Cela University, Villanueva de la Cañada, Madrid, Spain.
Pain Med. 2023 Mar 1;24(3):275-284. doi: 10.1093/pm/pnac121.
Current evidence suggests that fibromyalgia syndrome (FMS) involves complex underlying mechanisms. This study aimed to quantify the multivariate relationships between clinical, psychophysical, and psychological outcomes in women with FMS by using network analysis to understand the psychobiological mechanisms driving FMS and generating new research questions for improving treatment strategies.
Demographic (age, height, weight), clinical (pain history, pain intensity at rest and during daily living activities), psychophysical (widespread pressure pain thresholds [PPT]), sensory-related (PainDETECT, S-LANSS, Central Sensitization Inventory [CSI]) and psychological (depressive and anxiety levels) variables were collected in 126 women with FMS. Network analysis was conducted to quantify the adjusted correlations between the modeled variables and to assess their centrality indices (i.e., the connectivity with other symptoms in the network and the importance in the system modelled as network).
The network showed several local associations between psychophysical and clinical sensory-related variables. Multiple positive correlations between PPTs were observed, being the strongest weight between PPTs on the knee and tibialis anterior muscle (ρ: 0.33). PainDETECT was associated with LANSS (ρ: 0.45) and CSI (ρ: 0.24), whereas CSI was associated with HADS-A (ρ: 0.28). The most central variables were PPTs over the tibialis anterior (the highest Strength centrality) and CSI (the highest Closeness and Betweenness centrality).
Our findings support a model where clinical sensory-related, psychological, and psycho-physical variables are connected, albeit in separate clusters, reflecting a nociplastic condition with a relevant role of sensitization. Clinical implications of the findings, such as developing treatments targeting these mechanisms, are discussed.
现有证据表明，纤维肌痛综合征（FMS）涉及复杂的潜在机制。本研究旨在通过网络分析来量化 FMS 女性的临床、心理物理和心理结果之间的多变量关系，以了解驱动 FMS 的心理生物学机制，并为改善治疗策略提出新的研究问题。
收集了 126 名 FMS 女性的人口统计学（年龄、身高、体重）、临床（疼痛史、休息时和日常活动时的疼痛强度）、心理物理（广泛压痛阈值 [PPT]）、感觉相关（PainDETECT、S-LANSS、中枢敏化量表 [CSI]）和心理（抑郁和焦虑水平）变量。网络分析用于量化模型变量之间的调整相关性，并评估其中心性指数（即与网络中其他症状的连通性以及作为网络中模型系统的重要性）。
网络显示出心理物理和临床感觉相关变量之间的几个局部关联。观察到 PPT 之间存在多个正相关，膝关节和胫骨前肌之间的 PPT 最强（ρ：0.33）。PainDETECT 与 LANSS（ρ：0.45）和 CSI（ρ：0.24）相关，而 CSI 与 HADS-A（ρ：0.28）相关。最重要的变量是胫骨前肌上的 PPT（最高的强度中心性）和 CSI（最高的接近度和中间度中心性）。
我们的研究结果支持这样一种模型，即临床感觉相关、心理和心理物理变量是相互关联的，尽管是在不同的集群中，反映了一种具有显著敏感化作用的伤害感受性状态。讨论了这些发现的临床意义，例如开发针对这些机制的治疗方法。
