Salgado Afonso Shiguemi Inoue, Takemoto Miriam Hatsue, de Souza Carla Fernanda Tallarico Carvalho, Salm Daiana Cristina, da Rosa Danielli, Cardoso Gabriela Correa, Ludtke Daniela Dero, Soares Silvia Fiorillo Cabrera, Ferreira Júlia Koerich, Dutra Aline Raulino, Szeremeta Yuri Cordeiro, Mazzardo Gustavo, Mayra Joice, Sheffer Débora da Luz, Caumo Wolnei, Bittencourt Edsel B, Schleip Robert, Latini Alexandra, Bobinski Franciane, Martins Daniel Fernandes
Natural Quanta Wellness Center, Windermere, FL 32835, USA.
Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil.
J Clin Med. 2022 Aug 20;11(16):4898. doi: 10.3390/jcm11164898.
Fibromyalgia (FM) is considered a stress-related disorder characterized mainly by chronic widespread pain. Its pathogenesis is unknown, but cumulative evidence points at dysfunctional transmitter systems and inflammatory biomarkers that may underlie the major symptoms of the condition. This study aimed to evaluate pain scores (primary outcome), quality of life, inflammatory biomarkers and neurotransmitter systems in women with FM (secondary outcomes) subjected to gentle touch therapy (GTT) or placebo.
A total of 64 female patients with FM were randomly assigned to two groups, namely GTT (n = 32) or Placebo (n = 32). Clinical assessments were conducted at baseline and post-intervention with six-month follow-up. We measured serum catecholamines (dopamine), indolamines and intermediary metabolites (serotonin or 5-hydroxyindolacetic acid (5-HIAA)), as well as tetrahydrobiopterin (BH4), which is a cofactor for the synthesis of neurotransmitters and inflammatory biomarkers in women with FM. A group of healthy individuals with no intervention (control group) was used to compare biochemical measurements. Intervention effects were analyzed using repeated measures (RM) two-way ANOVA followed by Bonferroni post hoc test and mixed ANCOVA model with intention to treat.
Compared to placebo, the GTT group presented lower pain scores and brain-derived neurotrophic factor (BDNF) levels without altering the quality of life of women with FM. Changes in BDNF had a mediating role in pain. Higher baseline serum BDNF and 5-HIAA or those with a history of anxiety disorder showed a higher reduction in pain scores across time. However, women with higher serum dopamine levels at baseline showed a lower effect of the intervention across the observation period revealed by an ANCOVA mixed model.
In conclusion, lower pain scores were observed in the GTT group compared to the placebo group without altering the quality of life in women with FM. Reductions in BDNF levels could be a mechanism of FM pain status improvement. In this sense, the present study encourages the use of these GTT techniques as an integrative and complementary treatment of FM.
纤维肌痛（FM）被认为是一种与压力相关的疾病，主要特征为慢性广泛性疼痛。其发病机制尚不清楚，但越来越多的证据表明，功能失调的递质系统和炎症生物标志物可能是该疾病主要症状的基础。本研究旨在评估接受轻柔触摸疗法（GTT）或安慰剂治疗的FM女性患者的疼痛评分（主要结局）、生活质量、炎症生物标志物和神经递质系统（次要结局）。
总共64名FM女性患者被随机分为两组，即GTT组（n = 32）和安慰剂组（n = 32）。在基线期和干预后进行临床评估，并进行为期六个月的随访。我们测量了血清儿茶酚胺（多巴胺）、吲哚胺和中间代谢产物（血清素或5-羟吲哚乙酸（5-HIAA）），以及四氢生物蝶呤（BH4），它是FM女性患者神经递质和炎症生物标志物合成的辅助因子。一组未接受干预的健康个体（对照组）用于比较生化测量结果。使用重复测量（RM）双向方差分析，随后进行Bonferroni事后检验和意向性治疗的混合协方差分析模型来分析干预效果。
与安慰剂相比，GTT组的疼痛评分和脑源性神经营养因子（BDNF）水平较低，且未改变FM女性患者的生活质量。BDNF的变化在疼痛中起中介作用。基线血清BDNF和5-HIAA水平较高或有焦虑症病史的患者，其疼痛评分随时间的降低幅度更大。然而，通过协方差分析混合模型显示，基线血清多巴胺水平较高的女性在观察期内的干预效果较低。
总之，与安慰剂组相比，GTT组的疼痛评分较低，且未改变FM女性患者的生活质量。BDNF水平的降低可能是FM疼痛状态改善的一种机制。从这个意义上说，本研究鼓励将这些GTT技术用作FM的综合和补充治疗方法。
