Sprott H, Franke S, Kluge H, Hein G
Rheumatol Int. 1998;18(1):35-6. doi: 10.1007/s002960050051.
The lack of objective parameters makes the measurement of pain and the efficacy of pain treatment in patients with chronic pain very difficult. We performed acupuncture therapy in fibromyalgia patients and established a combination of methods to objectify pain measurement before and after therapy. The parameters corresponded to patients' self-report. Twenty-nine fibromyalgia patients as defined by ACR-criteria (25 women, 4 men) with a mean age of 48.2 +/- 2.0 years and a mean disease duration of 6.1 +/- 1.0 years participated in the study. Pain levels and positive tender points were assessed using the visual analogue scale (VAS, i.e., range 0-100 mm) and dolorimetry. Serotonin and substance P levels in serum and the serotonin concentration in platelets were measured concomitantly. During acupuncture therapy no analgesic medication was allowed. The VAS scores decreased from 64.0 +/- 3.4 mm before therapy to 34.5 +/- 4.3 mm after therapy (P < 0.001). Dolorimetry revealed a decreased number of tender points after therapy from 16.0 +/- 0.6 to 11.8 +/- 1.0, P < 0.01. Serotonin levels decreased from 715.8 +/- 225.8 micrograms/10(12) platelets to 352.4 +/- 47.9 micrograms/10(12) platelets (P < 0.01), whereas the serum concentration increased from 134.0 +/- 14.3 ng/ml to 171.2 +/- 14.6 ng/ml (P < 0.01). Substance P levels in serum increased from 43.4 +/- 3.5 pg/ml to 66.9 +/- 8.8 pg/ml (P < 0.01). Acupuncture treatment of patients with fibromyalgia was associated with decreased pain levels and fewer positive tender points as measured by VAS and dolorimetry. This was accompanied by decreased serotonin concentration in platelets and an increase of serotonin and substance P levels in serum. These results suggest that acupuncture therapy is associated with changes in the concentrations of pain-modulating substances in serum. The preliminary results are objective parameters for acupuncture efficacy in patients with fibromyalgia.
缺乏客观参数使得对慢性疼痛患者的疼痛测量以及疼痛治疗效果评估变得非常困难。我们对纤维肌痛患者进行了针刺治疗，并建立了一套方法来客观化治疗前后的疼痛测量。这些参数与患者的自我报告相符。29例符合美国风湿病学会（ACR）标准的纤维肌痛患者（25名女性，4名男性）参与了该研究，他们的平均年龄为48.2±2.0岁，平均病程为6.1±1.0年。使用视觉模拟量表（VAS，即范围为0 - 100毫米）和痛觉测量法评估疼痛水平和阳性压痛点。同时测量血清中的5-羟色胺和P物质水平以及血小板中的5-羟色胺浓度。在针刺治疗期间，不允许使用镇痛药物。VAS评分从治疗前的64.0±3.4毫米降至治疗后的34.5±4.3毫米（P < 0.001）。痛觉测量显示治疗后压痛点数量从16.0±0.6个减少至11.8±1.0个，P < 0.01。5-羟色胺水平从715.8±225.8微克/10¹²个血小板降至352.4±47.9微克/10¹²个血小板（P < 0.01），而血清浓度从134.0±14.3纳克/毫升升至171.2±14.6纳克/毫升（P < 0.01）。血清中的P物质水平从43.4±3.5皮克/毫升升至66.9±8.8皮克/毫升（P < 0.01）。通过VAS和痛觉测量法测得，针刺治疗纤维肌痛患者与疼痛水平降低以及阳性压痛点减少有关。这伴随着血小板中5-羟色胺浓度降低以及血清中5-羟色胺和P物质水平升高。这些结果表明，针刺治疗与血清中疼痛调节物质浓度的变化有关。这些初步结果是针刺治疗纤维肌痛患者疗效的客观参数。
