Sörensen J, Bengtsson A, Ahlner J, Henriksson K G, Ekselius L, Bengtsson M
Department of Anaesthesiology, University Hospital, Linköping, Sweden.
J Rheumatol. 1997 Aug;24(8):1615-21.
Pain was analyzed in patients with fibromyalgia (FM) in a randomized, double blind, crossover study using intravenous (i.v.) administration of different drugs.
In 18 patients with FM muscle pain to i.v. administration of morphine (0.3 mg/kg), lidocaine (5 mg/kg), ketamine (0.3 mg/kg), or saline was studied. Spontaneous pain intensity, muscle strength, static muscle endurance, pressure pain threshold, and pain tolerance at tender points and non-tender point areas were followed. Drug plasma concentrations and effects on physical functioning ability score (FIQ) were recorded. A personality inventory (KSP) was used to related pain response to personality traits.
Thirteen patients responded to one or several of the drugs, but not to placebo. Two patients were placebo responders responding to all 4 infusions. Three were nonresponders responding to no infusions. Seven of the responders had a reduction in pain for 1-5 days. Pressure pain threshold and pain tolerance increased significantly in responders. Plasma concentrations were similar in responders and nonresponders. FIQ values improved significantly after the ketamine infusion. Responders scored higher on KSP scales for somatic anxiety, muscular tension, and psychasthenia compared with healthy controls.
FM diagnosed according to the American College of Rheumatology criteria seems to include patients with different pain processing mechanisms. A pharmacological pain analysis with subdivision into responders and nonresponders might be considered before instituting therapeutic interventions or research.
在一项随机、双盲、交叉研究中，通过静脉注射不同药物，对纤维肌痛（FM）患者的疼痛情况进行分析。
对18例FM患者进行研究，静脉注射吗啡（0.3mg/kg）、利多卡因（5mg/kg）、氯胺酮（0.3mg/kg）或生理盐水，观察自发疼痛强度、肌肉力量、静态肌肉耐力、压痛阈值以及压痛点和非压痛点区域的疼痛耐受性。记录药物血浆浓度以及对身体功能能力评分（FIQ）的影响。使用人格量表（KSP）将疼痛反应与人格特质相关联。
13例患者对一种或几种药物有反应，但对安慰剂无反应。2例患者为安慰剂反应者，对所有4次输注均有反应。3例为无反应者，对任何输注均无反应。7例有反应者的疼痛减轻了1 - 5天。有反应者的压痛阈值和疼痛耐受性显著增加。有反应者和无反应者的血浆浓度相似。氯胺酮输注后FIQ值显著改善。与健康对照相比，有反应者在KSP量表上的躯体焦虑、肌肉紧张和精神衰弱得分更高。
根据美国风湿病学会标准诊断的FM似乎包括具有不同疼痛处理机制的患者。在进行治疗干预或研究之前，可考虑进行药理学疼痛分析，并将患者分为有反应者和无反应者。
