纤维肌痛中的兴奋性过高。

Hyperexcitability in fibromyalgia.

作者信息

Sörensen J, Graven-Nielsen T, Henriksson K G, Bengtsson M, Arendt-Nielsen L

机构信息

Department of Anaesthesiology, Pain Clinic, Linköping Hospital, Sweden.

出版信息

J Rheumatol. 1998 Jan;25(1):152-5.

PMID:9458220

Abstract

OBJECTIVE

Spontaneous chronic widespread pain in combination with hyperalgesia to pressure stimuli is the hallmark of fibromyalgia (FM). We tested whether muscular hyperalgesia can exist in a muscle without spontaneous pain, which could indicate a generalized hyperexcitability of the nociceptive system in patients with FM.

METHODS

Twelve women with FM and 12 age matched female controls participated in this blind study. Patients had no spontaneous pain in the anterior tibial (AT) muscle. The pressure pain threshold was tested on the AT muscle. The pain threshold to electrical single and repeated stimulations of the skin and of the right AT muscle was assessed. Pain was evoked in the left AT muscle by infusion of sterile hypertonic saline (5.7%, 2.8 ml over 480 s). The saline induced muscle pain intensity and duration were assessed by continuous recordings on an electronic visual analog scale (VAS), and the distribution of pain was assessed on drawings. The sequence of electrical sensibility tests and the infusion of hypertonic saline was randomized.

RESULTS

Pressure pain thresholds were lower (p < 0.02) in patients with FM compared to controls. Thresholds for pain evoked by electrical stimulation at the skin were not significantly different in the 2 groups. The pain threshold to repeated intramuscular stimulation was significantly (p = 0.02) lower for the patients with FM compared to the control group, indicating that the temporal nociceptive summation was more pronounced in patients with FM. This is an indication of central sensitization (hyperexcitability). Infusion of hypertonic saline evoked muscle pain with a longer duration (p = 0.01) in patients with FM, and referred pain that spread to a larger area (p = 0.002) than in controls. This is an indication of central hyperexcitability.

CONCLUSION

There is a state of central hyperexcitability in the nociceptive system in FM. This hyperexcitability can be revealed by excitation of intramuscular nociceptors in a muscle with no spontaneous pain.

摘要

目的

自发性慢性广泛性疼痛伴对压力刺激的痛觉过敏是纤维肌痛（FM）的标志。我们测试了在无自发疼痛的肌肉中是否存在肌肉痛觉过敏，这可能表明FM患者伤害性感受系统存在普遍的兴奋性增高。

方法

12名患有FM的女性和12名年龄匹配的女性对照参与了这项盲法研究。患者的胫前肌（AT）无自发疼痛。对AT肌进行压力疼痛阈值测试。评估皮肤和右侧AT肌单次和重复电刺激的疼痛阈值。通过输注无菌高渗盐水（5.7%，480秒内2.8毫升）在左侧AT肌诱发疼痛。通过电子视觉模拟量表（VAS）连续记录评估盐水诱发的肌肉疼痛强度和持续时间，并在图上评估疼痛分布。电敏感性测试和高渗盐水输注的顺序是随机的。

结果

与对照组相比，FM患者的压力疼痛阈值较低（p < 0.02）。两组皮肤电刺激诱发疼痛的阈值无显著差异。与对照组相比，FM患者重复肌肉内刺激的疼痛阈值显著降低（p = 0.02），表明FM患者的时间性伤害性总和更明显。这表明存在中枢敏化（兴奋性增高）。与对照组相比，FM患者输注高渗盐水诱发的肌肉疼痛持续时间更长（p = 0.01），牵涉痛扩散到更大区域（p = 0.002）。这表明存在中枢兴奋性增高。