Gibson S J, Littlejohn G O, Gorman M M, Helme R D, Granges G
National Research Institute of Gerontology and Geriatric Medicine, North West Hospital, Mount Royal Campus, Parkville, Victoria 3052 Australia Department of Medicine, Monash Medical Centre, Clayton, Victoria 3168 Australia.
Pain. 1994 Aug;58(2):185-193. doi: 10.1016/0304-3959(94)90198-8.
A decrease in mechanical pressure pain thresholds, particularly over pre-designated tender points, is one of the defining characteristics of fibromyalgia syndrome (FS); however, changes in thermal pain sensitivity have not been investigated. The present study examined heat pain thresholds and cerebral event-related potentials following CO2 laser stimulation in 10 subjects with FS and 10 age-matched control volunteers. The results indicate that patients with FS exhibit a significant reduction in heat pain threshold when tested on the dorsal surface of the hand. In accordance with previous research, we also found a decrease in mechanical pain threshold over pre-designated tender points and at control sites as well as a significantly larger mechanically induced neurogenic flare response. These measures were highly correlated with thermal pain threshold even though different anatomical sites were stimulated. Hence, it seems likely that FS patients display a multimodal change in pain sensitivity which is generalized rather than anatomically restricted. Patients with FS also displayed a significant increase in the peak-to-peak amplitude of the cerebral potential evoked by CO2 laser stimulation at pain threshold intensity and 1.5 times pain threshold intensity. These findings suggest a greater activation of central nervous system (CNS) pathways following noxious input. Putative explanations for the increased CNS response are discussed, including mechanisms of peripheral nociceptor sensitization, altered CNS function and the role of psychological factors.
机械性压痛阈值降低，尤其是在预先指定的压痛点处，是纤维肌痛综合征（FS）的主要特征之一；然而，热痛敏感性的变化尚未得到研究。本研究检测了10名FS患者和10名年龄匹配的对照志愿者在二氧化碳激光刺激后的热痛阈值和脑事件相关电位。结果表明，FS患者在手背部进行测试时，热痛阈值显著降低。与先前的研究一致，我们还发现预先指定的压痛点和对照部位的机械性痛阈降低，以及机械性诱发的神经源性 flare 反应明显更大。尽管刺激的是不同的解剖部位，但这些指标与热痛阈值高度相关。因此，FS患者似乎表现出疼痛敏感性的多模式变化，这种变化是全身性的而非局限于解剖部位。FS患者在疼痛阈值强度和1.5倍疼痛阈值强度的二氧化碳激光刺激诱发的脑电位峰峰值幅度也显著增加。这些发现表明，有害输入后中枢神经系统（CNS）通路的激活增强。文中讨论了CNS反应增加的可能解释，包括外周伤害感受器敏化机制、CNS功能改变以及心理因素的作用。
