Central sensitisation in chronic fatigue syndrome and fibromyalgia; a case control study
Central sensitisation in chronic fatigue syndrome and fibromyalgia; a case control study
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DOI：
10.1016/j.jpsychores.2021.110624
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发表时间：
2021-09-30
影响因子：
4.7
通讯作者：
White, Peter D.
中科院分区：
文献类型：
--
作者：
Bourke, Julius H.;Wodehouse, Theresa;White, Peter D.
简介：慢性疲劳综合征（CFS）和纤维肌痛（FM）都是复杂的疾病，治疗具有挑战性。这可能与对它们的病理生理学的不完全理解有关，其本身被它们的异质性所混淆。他们之间的症状重叠和他们共同的合并症表明一个共同的脆弱性，这可能是解释中央sensitisation.Methods：19 CFS的情况下，19 FM的情况下，20年龄和性别匹配的健康对照（HC）主要从二级保健诊所在伦敦招募。那些有其他疼痛障碍，精神病诊断和那些采取集中作用或阿片类药物被排除在外。参与者被要求在静态和动态定量感觉测试评估前48小时戒酒和非处方镇痛药，包括时间总和（TS）和条件性疼痛调制（CPM）的测量。CS，即同时存在增强的TS和无效的CPM，存在于16例（84%）CFS病例，18例（95%）FM病例，而HC中没有（p < 0.001）。CFS（中位数222 kPa IQR 146-311; p = 0.04）和FM病例（中位数189 kPa; IQR 129-272; p = 0.003）的压痛阈值低于HC（中位数311 kPa; IQR 245-377）。FM病例与HC在冷诱导的（FM = 22.6 ℃（15.3-27.7）vs HC = 14.2 ℃（9.0-20.5）; p = 0.01）和热诱导（FM = 38.0 ℃（35.2-44.0）vs HC = 45.3 ℃（40.1-46.8）; p = 0.03）疼痛阈值，而CFS病例没有。中枢致敏可能是慢性疲劳综合征和纤维肌痛的常见内在表型。进一步的研究应该解决中枢敏感化是否是这些疾病的原因或结果。
Introduction: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are both complex conditions that are challenging to treat. This may be related to an incomplete understanding of their pathophysiology, itself obfuscated by their heterogeneity. The symptomatic overlap between them and their common comorbidity suggests a shared vulnerability, which might be explained by central sensitisation.Methods: 19 CFS cases, 19 FM cases and 20 age and sex matched healthy controls (HC) were recruited primarily from secondary care clinics in London. Those with other pain disorders, psychiatric diagnoses and those taking centrally acting or opiate medications were excluded. Participants were asked to abstain from alcohol and over the counter analgaesia 48 h prior to assessment by static and dynamic quantitative sensory tests, including measures of temporal summation (TS) and conditioned pain modulation (CPM).Results: CS, as defined by the presence of both enhanced TS and inefficient CPM, was present in 16 (84%) CFS cases, 18 (95%) FM cases, and none of the HC (p < 0.001). Pressure pain thresholds were lower in CFS (Median222kPaIQR 146-311; p = 0.04) and FM cases (Median 189 kPa; IQR 129-272; p = 0.003) compared to HC (Median 311 kPa; IQR 245-377). FM cases differed from HC in cold-induced (FM = 22.6 degrees C (15.3-27.7) vs HC = 14.2 degrees C (9.0-20.5); p = 0.01) and heat-induced (FM = 38.0 degrees C (35.2-44.0) vs HC = 45.3 degrees C (40.1-46.8); p = 0.03) pain thresholds, where CFS cases did not.Conclusion: Central sensitisation may be a common endophenotype in chronic fatigue syndrome and fibromy-algia. Further research should address whether central sensitisation is a cause or effect of these disorders.