Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia
Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia
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DOI：
10.1016/j.pain.2003.05.001
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发表时间：
2004-01-01
期刊：
影响因子：
7.4
通讯作者：
Curatolo, M
中科院分区：
文献类型：
--
作者：
Banic, B;Petersen-Felix, S;Curatolo, M
鞭打损伤后的慢性疼痛患者和纤维肌痛患者在感觉刺激后表现出夸大的疼痛。由于通常缺乏明显的组织损伤，这种夸大的疼痛感觉可以用中枢神经系统的过度兴奋来解释。伤害性撤退反射(脊髓反射)可用于研究脊髓神经元的兴奋性状态。我们测试了一种假说，即慢性鞭打疼痛和纤维肌痛的患者表现出促进撤退反射，从而导致脊髓过敏。研究分为三组：鞭打组(n=27)、纤维肌痛组(n=22)和健康对照组(n=29)。经皮电刺激腓肠神经分为两种：1次刺激和5次重复刺激，频率2 Hz。从股二头肌记录肌电。主要测量结果是引起脊髓反射的最小电流强度(反射阈值)。无论是单次刺激(P=0.024)还是重复刺激(P=0.035)，鞭打组大鼠的反射阈值均显著低于对照组。纤维肌痛组在两种刺激方式后也观察到同样的情况(P=0.001和0.046)。我们为鞭打损伤后慢性疼痛患者和纤维肌痛患者提供了脊髓过度兴奋的证据。这可能会在低强度的伤害性或无害的外周刺激后导致夸大的疼痛。脊柱过敏症可能至少部分解释了在没有可检测到的组织损伤的情况下的疼痛。(C)2003年，由爱思唯尔公司代表国际疼痛研究协会出版。
Patients with chronic pain after whiplash injury and fibromyalgia patients display exaggerated pain after sensory stimulation. Because evident tissue damage is usually lacking, this exaggerated pain perception could be explained by hyperexcitability of the central nervous system. The nociceptive withdrawal reflex (a spinal reflex) may be used to study the excitability state of spinal cord neurons. We tested the hypothesis that patients with chronic whiplash pain and fibromyalgia display facilitated withdrawal reflex and therefore spinal cord hypersensitivity. Three groups were studied: whiplash (n = 27), fibromyalgia (n = 22) and healthy controls (n = 29). Two types of transcutaneous electrical stimulation of the sural nerve were applied: single stimulus and five repeated stimuli at 2 Hz. Electromyography was recorded from the biceps femoris muscle. The main outcome measurement was the minimum current intensity eliciting a spinal reflex (reflex threshold). Reflex thresholds were significantly lower in the whiplash compared with the control group, after both single (P = 0.024) and repeated (P = 0.035) stimulation. The same was observed for the fibromyalgia group, after both stimulation modalities (P = 0.001 and 0.046, respectively). We provide evidence for spinal cord hyperexcitability in patients with chronic pain after whiplash injury and in fibromyalgia patients. This can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain, at least in part, pain in the absence of detectable tissue damage. (C) 2003 Published by Elsevier B.V. on behalf of International Association for the Study of Pain.