纤维肌痛患者疼痛抑制和易化的效率与健康对照无差异：敏感性调整测试刺激的相关性。
Efficiency of pain inhibition and facilitation of fibromyalgia patients is not different from healthy controls: Relevance of sensitivity-adjusted test stimuli.
作者信息
Staud Roland, Godfrey Melyssa M, Riley Joseph L, Fillingim Roger B
机构信息
Department of Medicine, University of Florida, Gainesville, FL, USA.
College of Dentistry, University of Florida, Gainesville, FL, USA.
出版信息
Br J Pain. 2023 Apr;17(2):182-194. doi: 10.1177/20494637221138318. Epub 2022 Dec 6.
BACKGROUND
Pain is a dynamic phenomenon dependent on the balance of endogenous excitatory and inhibitory systems, which can be characterized by quantitative sensory testing. Many previous studies of pain modulatory capacity of patients with fibromyalgia syndrome (FM) have reported decreased pain inhibition or increased pain facilitation. This is the first study to assess pain modulation, including conditioned pain modulation (CPM) and temporal pain summation, in the same healthy control (HC) and FM participants.
METHODS
Only sensitivity-adjusted stimuli were utilized for testing of conditioned pain modulation (CPM) and temporal pain summation in 23 FM patients and 28 HC. All subjects received sensitivity-adjusted ramp-hold (sRH) during testing of pain facilitation (temporal summation) and pain inhibition (CPM). CPM efficacy was evaluated with test stimuli applied either concurrently or after application of the conditioning stimulus. Finally, the effects of CPM on pressure pain thresholds were tested.
RESULTS
FM subjects required significantly less intense test and conditioning stimuli than HC participants to achieve standardized pain ratings of 50 ± 10 numerical rating scale (NRS) ( = 0.03). Using such stimuli, FM subjects' temporal pain summation and CPM efficacy was not significantly different from HC (all > 0.05), suggesting similar pain facilitation and inhibition. Furthermore, the CPM efficacy of FM and HC participants was similar regardless of whether the test stimuli were applied during or after the conditioning stimulus ( > 0.05).
CONCLUSION
Similar to previous studies, FM participants demonstrated hyperalgesia to heat, cold, and mechanical stimuli. However, using only sensitivity-adjusted stimuli during CPM and temporal summation testing, FM patients demonstrated similarly effective pain inhibition and facilitation than HC, suggesting that their pain modulation is not abnormal.
背景
疼痛是一种动态现象，取决于内源性兴奋和抑制系统的平衡，可通过定量感觉测试来表征。之前许多关于纤维肌痛综合征（FM）患者疼痛调节能力的研究报告称其疼痛抑制降低或疼痛易化增加。这是第一项在相同的健康对照（HC）和FM参与者中评估疼痛调节的研究，包括条件性疼痛调节（CPM）和时间性疼痛总和。
方法
仅使用敏感性调整后的刺激来测试23名FM患者和28名HC的条件性疼痛调节（CPM）和时间性疼痛总和。在疼痛易化（时间总和）和疼痛抑制（CPM）测试期间，所有受试者均接受敏感性调整后的斜坡-保持（sRH）刺激。通过同时或在施加条件刺激后施加测试刺激来评估CPM疗效。最后，测试CPM对压力疼痛阈值的影响。
结果
与HC参与者相比，FM受试者达到标准化疼痛评分50±10数字评分量表（NRS）所需的测试和条件刺激强度明显更低（ = 0.03）。使用这些刺激时，FM受试者的时间性疼痛总和和CPM疗效与HC无显著差异（均 ＞ 0.05），表明疼痛易化和抑制相似。此外，无论测试刺激是在条件刺激期间还是之后施加，FM和HC参与者的CPM疗效相似（ ＞ 0.05）。
结论
与之前的研究相似，FM参与者对热、冷和机械刺激表现出痛觉过敏。然而，在CPM和时间总和测试中仅使用敏感性调整后的刺激时，FM患者表现出与HC相似有效的疼痛抑制和易化，表明他们的疼痛调节并无异常。
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