Temporal Summation in Fibromyalgia Patients: Comparing Phasic and Tonic Paradigms.
Temporal Summation in Fibromyalgia Patients: Comparing Phasic and Tonic Paradigms.
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DOI：
10.3389/fpain.2022.881543
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发表时间：
2022
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纤维肌痛（FM）与功能失调的疼痛调节机制有关，包括中枢致敏。实验性疼痛测量，如时间总和（TS），可以作为中枢致敏的标志物，并已在这些患者中进行了研究，结果相互矛盾。本研究的目的是探讨两种不同的TS方案（阶段性和紧张性）之间的关系，并测试这些措施和其他临床变量之间的关联。在这项随机临床试验的横断面分析中，患者被指示确定他们的疼痛-60测试温度，然后接受一系列15次重复的热刺激，并在第1次和第15次刺激后对他们的疼痛进行评级：TSPS阶段计算为两者之间的差异。我们还在相同的温度下连续30 s进行了热强直测试刺激，并要求他们在10 s和30 s后评估他们的疼痛水平，计算TSPS-tonic作为它们之间的差异。我们还收集了基线人口统计学数据和行为问卷，评估疼痛、抑郁、疲劳、焦虑、嗜睡和生活质量。我们对TSPS-阶段性和TSPS-紧张性之间的关系，以及这些措施与基线时收集的人口统计学和临床变量之间的关系进行了单变量分析。然后，我们建立了多变量线性回归模型，以找到TSPS阶段性和TSPS紧张性的预测因子，同时包括潜在的混杂因素并避免共线性。分析了52例FM患者。28.85%的患者在TSPS阶段性方案期间发生了总和，而21.15%的患者在TSPS强直方案期间发生了总和。在单变量分析中，没有与TSPS相位或强直相关的变量，两项指标均不相关。在TSPS阶段协议的多变量模型中，我们发现与疼痛变量的弱相关性。在阶段性方案中，BPI-疼痛子量表与更多的时间总和相关（P = 0.38，p = 0.029），而在TSPS-强直性方案中，疼痛VAS与更少的总和相关（P =-0.5，p = 0.009）。我们的研究结果表明，使用热刺激与疼痛-60度的温度，TSPS-阶段性协议和TSPS-滋补协议是不相关的，可以索引不同的神经反应FM科目。需要更大样本量的进一步研究来阐明这种反应是否有助于将FM受试者区分为特定的表型。
Fibromyalgia (FM) is associated with dysfunctional pain modulation mechanisms, including central sensitization. Experimental pain measurements, such as temporal summation (TS), could serve as markers of central sensitization and have been previously studied in these patients, with conflicting results. Our objective in this study was to explore the relationships between two different protocols of TS (phasic and tonic) and test the associations between these measures and other clinical variables. In this cross-sectional analysis of a randomized clinical trial, patients were instructed to determine their pain-60 test temperature, then received one train of 15 repetitive heat stimuli and rated their pain after the 1st and 15th stimuli: TSPS-phasic was calculated as the difference between those. We also administered a tonic heat test stimulus at the same temperature continuously for 30 s and asked them to rate their pain levels after 10 s and 30 s, calculating TSPS-tonic as the difference between them. We also collected baseline demographic data and behavioral questionnaires assessing pain, depression, fatigue, anxiety, sleepiness, and quality of life. We performed univariable analyses of the relationship between TSPS-phasic and TSPS-tonic, and between each of those measures and the demographic and clinical variables collected at baseline. We then built multivariable linear regression models to find predictors for TSPS-phasic and TSPS-tonic, while including potential confounders and avoiding collinearity. Fifty-two FM patients were analyzed. 28.85% developed summation during the TSPS-phasic protocol while 21.15% developed summation during the TSPS-tonic protocol. There were no variables associated TSPS phasic or tonic in the univariable analyses and both measures were not correlated. On the multivariate model for the TSPS-phasic protocol, we found a weak association with pain variables. BPI-pain subscale was associated with more temporal summation in the phasic protocol (ß = 0.38, p = 0.029), while VAS for pain was associated with less summation in the TSPS-tonic protocol (ß = −0.5, p = 0.009). Our results suggest that, using heat stimuli with pain-60 temperatures, a TSPS-phasic protocol and a TSPS-tonic protocol are not correlated and could index different neural responses in FM subjects. Further studies with larger sample sizes would be needed to elucidate whether such responses could help differentiating subjects with FM into specific phenotypes.
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