Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients.
Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients.
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DOI：
10.1371/journal.pone.0089086
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Fillingim RB
中科院分区：
文献类型：
--
作者：
Staud R;Weyl EE;Riley JL 3rd;Fillingim RB
在健康个体中，频率≥.33 Hz 的重复热脉冲可引起疼痛或结束 (WU) 的缓慢时间总和。 WU 之前的研究使用了各种刺激频率和强度来表征人类受试者（包括纤维肌痛 (FM) 患者）的中枢敏化。然而，许多试验证明了相当大的 WU 变异性，包括零 WU 甚至在足以激活 C 伤害感受器的刺激强度下的放松 (WD)。此外，很少有 WU 协议能够控制个体疼痛敏感性对 WU 幅度的影响，这对于 WU 比较至关重要。我们假设将 3 个不同的 WU 序列整合到单个 WU 响应函数 (WU-RF) 中不仅可以控制个体的疼痛敏感性，而且可以更好地表征他们的中枢疼痛反应，包括 WU 和 WD。 33 名正常对照 (NC) 和 38 名 FM 患者参与了 heat-WU 研究。我们系统地改变了施加到手上的 4 Hz 热脉冲序列的刺激强度。疼痛总和计算为第一和第五热脉冲等级的差异分数。与 3 个热脉冲序列（44°C、46°C、48°C）相关的 WU 差异 (WU-Δ) 分数被整合到 WU 反应函数中，其斜率用于评估中枢疼痛敏感性的组间差异。 15 秒和 30 秒的 WU 后感觉 (WU-AS) 用于预测临床 FM 疼痛强度。从 WD 到 WU，两组受试者 (FM>NC) 的 WU-Δ 分数随着刺激强度的增加而线性加速 (p<.001)。代表中枢疼痛敏感性的 WU-RF 斜率在 FM 患者中比 NC 患者显着更陡 (p<.003)。 WU-AS 预测临床 FM 疼痛强度（Pearson’s r = .4；p<.04）。与单个 WU 系列相比，WU-RF 集成了个体的疼痛敏感性以及 WU 和 WD。 FM 患者和 NC 患者之间 WU-RF 的斜率显着不同。因此，WU-RF 可能有助于在研究和临床实践中评估慢性疼痛患者的中枢敏化。
In healthy individuals slow temporal summation of pain or wind-up (WU) can be evoked by repetitive heat-pulses at frequencies of ≥.33 Hz. Previous WU studies have used various stimulus frequencies and intensities to characterize central sensitization of human subjects including fibromyalgia (FM) patients. However, many trials demonstrated considerable WU-variability including zero WU or even wind-down (WD) at stimulus intensities sufficient for activating C-nociceptors. Additionally, few WU-protocols have controlled for contributions of individual pain sensitivity to WU-magnitude, which is critical for WU-comparisons. We hypothesized that integration of 3 different WU-trains into a single WU-response function (WU-RF) would not only control for individuals’ pain sensitivity but also better characterize their central pain responding including WU and WD. 33 normal controls (NC) and 38 FM patients participated in a study of heat-WU. We systematically varied stimulus intensities of.4 Hz heat-pulse trains applied to the hands. Pain summation was calculated as difference scores of 1st and 5th heat-pulse ratings. WU-difference (WU-Δ) scores related to 3 heat-pulse trains (44°C, 46°C, 48°C) were integrated into WU-response functions whose slopes were used to assess group differences in central pain sensitivity. WU-aftersensations (WU-AS) at 15 s and 30 s were used to predict clinical FM pain intensity. WU-Δ scores linearly accelerated with increasing stimulus intensity (p<.001) in both groups of subjects (FM>NC) from WD to WU. Slope of WU-RF, which is representative of central pain sensitivity, was significantly steeper in FM patients than NC (p<.003). WU-AS predicted clinical FM pain intensity (Pearson’s r = .4; p<.04). Compared to single WU series, WU-RFs integrate individuals’ pain sensitivity as well as WU and WD. Slope of WU-RFs was significantly different between FM patients and NC. Therefore WU-RF may be useful for assessing central sensitization of chronic pain patients in research and clinical practice.
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