Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or fibromyalgia patients
Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or fibromyalgia patients
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DOI：
10.1016/s0304-3959(02)00325-1
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发表时间：
2003-01-01
期刊：
影响因子：
7.4
通讯作者：
Price, DD
中科院分区：
文献类型：
--
作者：
Staud, R;Robinson, ME;Price, DD
弥漫性伤害性抑制控制（DNIC）是依赖于脊髓和脊髓上机制的中枢疼痛调节系统的一部分。先前的研究表明，与正常对照（NC）受试者相比，纤维肌痛（FMS）患者对实验性疼痛缺乏DNIC效应。由于DNIC对第二次疼痛的影响大于对第一次疼痛的影响，我们假设第二次疼痛的结束（WU）应该被强烈的条件刺激所减弱。因此，我们比较了DNIC对三组受试者WU的影响：11 I NC男性，22 NC女性和11 FMS女性。为了分别评估分心相关机制对抑制第二次疼痛的贡献，我们设计了这样一种实验，即将受试者的注意力引导到测试或条件刺激上。对右手大鱼际表面的重复热敲击被用作产生第二疼痛的WU的测试刺激。将左手浸入热水浴是条件反射刺激。如先前的实验所示，DNIC需要强的条件刺激来减轻疼痛，这可能至少部分取决于分心效应。在正常男性受试者中，DNIC显著抑制热WU疼痛，但在DNIC效应中加入分心并没有增加这种抑制的程度。相比之下，无论是DNIC或DNIC加牵引衰减热WU疼痛的女性NC。在女性FMS患者中，DNIC加牵引而非单独DNIC对热性WU疼痛产生显著抑制作用。我们的研究结果表明，DNIC对第二次疼痛的实验性WU的影响是性别特异性的，女性通常缺乏这种疼痛抑制机制。(C)2002年国际疼痛研究协会。由Elsevier Science B.V.出版，版权所有。
Diffuse noxious inhibitory control (DNIC) is part of a central pain modulatory system that relies on spinal and supraspinal mechanisms. Previous studies have shown that fibromyalgia (FMS) patients are lacking DNIC effects on experimental pain, compared to normal control (NC) subjects. Because DNIC has a greater effect on second pain than on first pain, we hypothesized that wind-up (WU) of second pain should be attenuated by a strong conditioning stimulus. Thus, we compared DNIC's effect on WU in three groups of subjects: 11I NC males, 22 NC females, and 11 FMS females. To separately assess the contributions of distraction related mechanisms to inhibition of second pain, we designed the experiment in such a way that directed the subjects' attention to either the test or conditioning stimulus. Repeated heat taps to the thenar surface of the right hand were used as test stimuli to generate WU of second pain. Immersion of the left hand into a hot water bath was the conditioning stimulus. As previous experiments have shown, DNIC requires a strong conditioning stimulus for pain attenuation, which may be at least partly dependent on a distraction effect. DNIC significantly inhibited thermal WU pain in normal male subjects, but adding distraction to the DNIC effect did not increase the extent of this inhibition. In contrast, neither DNIC nor DNIC plus distraction attenuated thermal WU pain in female NCs. DNIC plus distraction but not DNIC alone produced significant inhibition of thermal WU pain in female FMS patients. Our results indicate that DNIC effects on experimental WU of second pain are gender specific, with women generally lacking this pain-inhibitory mechanism. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.