纤维肌痛患者疼痛药物使用与定量感觉测试结果的关联：一项二次数据分析

The Association of Pain Medication Usage and Quantitative Sensory Testing Outcomes in Fibromyalgia Patients: A Secondary Data Analysis.

作者信息

Alves Luana Gola, Pacheco-Barrios Kevin, Lacerda Guilherme J M, Fregni Felipe

机构信息

Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02138, USA.

Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru.

出版信息

NeuroSci. 2025 Feb 10;6(1):15. doi: 10.3390/neurosci6010015.

DOI:10.3390/neurosci6010015

PMID:39982267

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11843844/

Abstract

BACKGROUND

Fibromyalgia syndrome (FMS), a chronic pain syndrome affecting 0.2-6.6% of the general population, is known for its challenging diagnosis and treatment. The known dysregulation in the Endogenous Pain Modulatory System (EPMS) characteristic of the pathology contributes to enhanced pain sensitivity. Fibromyalgia patients, who are often overmedicated, may experience, in addition to the drug-related known adverse effects, effects on fibromyalgia sensory-related outcomes. Therefore, the focus of this analysis is to explore the bidirectional drug-sensory outcome interactions, indexed by the conditioned pain modulation (CPM), an important assessment element in regard to an EPMS's efficacy.

METHODS

Baseline data from a randomized, double-blind, single-center (Boston-based tertiary hospital) clinical trial (NCT03371225) were analyzed. Participants aged 18-65 with an FMS diagnosis and resistance to common analgesics were included. Demographic, clinical, and sensory variables, including CPM, temporal summation, and Pain-60 outcomes, were collected alongside a pain medication diary. Multivariable regression models adjusted for confounders were applied to explore associations between medication classes and quantitative sensory outcomes.

RESULTS

Out of 101 recruited FMS patients, we categorized the use of the following medications: antidepressants with 50% use ( = 50), muscle relaxants with 26% use ( = 26), and gabapentin with 25% use ( = 25). The results showed that antidepressant use correlated with worsened CPM, Odds Ratio = 0.39 (95% CI = 0.17-0.91), while muscle relaxants were linked to increased TSPS, β coefficient = 0.72 (95% CI = 0.0021-1.4431). On the other hand, gabapentin use was associated with elevated Pain-60, OR = 2.68 (95% CI = 0.98-7.31). Interestingly, the use of low doses of opioids was not associated with altered sensory measures.

CONCLUSION

This cross-sectional analysis suggests that common pain medications may affect quantitative sensory outcomes in FMS patients. We provided important insights into bidirectional drug-sensory outcome interactions and their influence on pain medicine.

摘要

背景

纤维肌痛综合征（FMS）是一种慢性疼痛综合征，影响着0.2%至6.6%的普通人群，以其诊断和治疗具有挑战性而闻名。已知该病理特征的内源性疼痛调节系统（EPMS）失调会导致疼痛敏感性增强。纤维肌痛患者常常用药过量，除了药物相关的已知不良反应外，还可能经历对纤维肌痛感觉相关结果的影响。因此，本分析的重点是探讨双向药物 - 感觉结果相互作用，以条件性疼痛调制（CPM）为指标，CPM是评估EPMS功效的一个重要元素。

方法

分析了一项随机、双盲、单中心（位于波士顿的三级医院）临床试验（NCT03371225）的基线数据。纳入年龄在18至65岁、诊断为FMS且对常用镇痛药耐药的参与者。收集了人口统计学、临床和感觉变量，包括CPM、时间总和以及疼痛 - 60结果，同时还有一份疼痛用药日记。应用针对混杂因素进行调整的多变量回归模型来探讨药物类别与定量感觉结果之间的关联。

结果

在招募的101名FMS患者中，我们对以下药物的使用情况进行了分类：50%的患者使用抗抑郁药（n = 50），26%的患者使用肌肉松弛剂（n = 26），25%的患者使用加巴喷丁（n = 25）。结果显示，使用抗抑郁药与CPM恶化相关，比值比 = 0.39（95%置信区间 = 0.17 - 0.91），而使用肌肉松弛剂与时间总和疼痛敏感性增加相关，β系数 = 0.72（95%置信区间 = 0.0021 - 1.4431）。另一方面，使用加巴喷丁与疼痛 - 60升高相关，比值比 = 有2.68（95%置信区间 = 0.98 - 7.31）。有趣的是，使用低剂量阿片类药物与感觉测量的改变无关。