Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, Michigan; Department of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, Michigan.
J Pain. 2024 Oct;25(10):104622. doi: 10.1016/j.jpain.2024.104622. Epub 2024 Jul 8.
Fibromyalgia (FM) is a common chronic pain condition for which acupuncture treatment is increasingly utilized. However, there is no universally accepted measure to predict whether a specific patient will benefit from acupuncture. This is a single-center, single-blind, sham-controlled, randomized, noncrossover, longitudinal trial of 76 subjects with FM, assigned to either electroacupuncture (EA) or a placebo control, mock laser (ML) acupuncture. Outcome measures included clinical pain severity (Brief Pain Inventory [BPI]), degree of nociplastic pain (Fibromyalgia Survey Questionnaire), and pressure pain tolerance (PPtol). Baseline measures of temporal summation of pain and expectations for treatment relief were used as predictors. Individuals in both treatment groups experienced significant reductions in BPI (EA: P < .001, ML: P = .018) and Fibromyalgia Survey Questionnaire (EA: P = .032, ML: P = .002) after treatment; however, neither group showed a significant increase in PPtol. Lower temporal summation at baseline was correlated with greater post-treatment improvement in BPI in the EA group (rho = .389, P = .025) but not in the ML group (rho = -.272, P = .109). Lower-baseline temporal summation was correlated with greater decreases in PPtol following EA (rho = .400, P = .040), whereas the opposite was seen for ML (rho = -.562, P = .001). Treatment expectancy at baseline was not correlated with any outcome after EA or ML treatments. Our results support using a quantitative sensory testing metric, temporal summation of pain, but not expectations, to predict analgesia following acupuncture treatment for pain. PERSPECTIVE: A randomized study of acupuncture in FM found baseline temporal summation, but not expectations of pain relief, to be predictive of treatment response. CLINICAL TRIAL REGISTRATION: Registered under ClinicalTrials.gov identifier NCT02064296.
纤维肌痛（FM）是一种常见的慢性疼痛病症，越来越多地采用针刺治疗。然而，目前尚无普遍接受的方法来预测特定患者是否会从针刺中受益。这是一项针对 76 名 FM 患者的单中心、单盲、假对照、随机、非交叉、纵向试验，将患者分为电针（EA）或假激光（ML）针刺对照。结局指标包括临床疼痛严重程度（简明疼痛量表[BPI]）、痛觉过敏程度（纤维肌痛调查问卷）和压力疼痛耐受度（PPtol）。使用疼痛时间总和和对治疗缓解的期望作为预测指标。两组治疗组个体的 BPI（EA：P<.001，ML：P=.018）和纤维肌痛调查问卷（EA：P=.032，ML：P=.002）均显著降低；然而，两组的 PPTol 均未显著增加。基线时时间总和越低，EA 组 BPI 治疗后改善越大（rho=0.389，P=0.025），但 ML 组无相关性（rho=-.272，P=0.109）。基线时时间总和越低，EA 后 PPTol 降低越大（rho=0.400，P=0.040），而 ML 组则相反（rho=-.562，P=0.001）。基线时的治疗期望与 EA 或 ML 治疗后的任何结果均无相关性。我们的结果支持使用定量感觉测试指标，即疼痛时间总和，而不是对疼痛缓解的期望，来预测针刺治疗疼痛的镇痛效果。观点：一项针对 FM 的针刺随机研究发现，基线时间总和，而不是对缓解疼痛的期望，可预测治疗反应。临床试验注册：在 ClinicalTrials.gov 注册标识符 NCT02064296 下注册。
