Autonomic cardiovascular control and responses to experimental pain stimulation in fibromyalgia syndrome
Autonomic cardiovascular control and responses to experimental pain stimulation in fibromyalgia syndrome
复制标题
DOI：
10.1016/j.jpsychores.2010.09.012
复制
发表时间：
2011-02-01
影响因子：
4.7
通讯作者：
Duschek, Stefan
中科院分区：
文献类型：
--
作者：
Reyes del Paso, Gustavo A.;Garrido, Sergio;Duschek, Stefan
目的：全面研究纤维肌痛综合征（FMS）静息和疼痛刺激时的自主心血管调节及其与疼痛指数的关系。方法：对35例患者和29例健康对照进行心电图、阻抗心动图和手指连续血压测量。为达到实验性疼痛诱导的目的，采用冷压试验。结果：FMS患者的疼痛阈值和耐受性较低，疼痛强度和不愉快程度在视觉模拟量表上评分较高。患者的静息脑卒中容量、心肌收缩力、R-R间期、心率变异性和心脏压力反射敏感性均降低，冷压刺激时脑卒中容量和心肌收缩力的增加较不明显。在整个样本和FMS组中，压力反射敏感性与主观疼痛强度呈负相关，单位时间内压力反射操作次数越多，疼痛耐受性越高。结论：数据表明FMS的自主心血管调节功能受损，包括交感神经和副交感神经的影响减弱，以及交感神经对急性应激的反应减弱。压力反射功能与疼痛体验之间的关联反映了由压力感受器系统介导的疼痛抑制。考虑到FMS的压力反射敏感性降低，人们可能认为心血管系统引起的上升疼痛抑制不足，这可能导致FMS的疼痛敏感性夸大。(C) 2011爱思唯尔公司版权所有。
Objective: This study involves a comprehensive investigation of autonomic cardiovascular regulation in fibromyalgia syndrome (FMS) at rest and during painful stimulation and its association with pain indices. Methods: In 35 patients and 29 healthy controls, electrocardiography, impedance cardiography, and finger continuous blood pressure measurements were conducted. For the purpose of experimental pain induction, a cold pressor test was applied. Results: FMS patients showed lower pain threshold and tolerance, as well as higher ratings of pain intensity and unpleasantness on visual analogue scales. Resting stroke volume, myocardial contractility, R-R interval, heart rate variability, and sensitivity of the cardiac baroreflex were reduced in the patients, and increases in stroke volume and myocardial contractility during cold pressor stimulation were less proflounced. In the whole sample as well as in the FMS group, baroreflex sensitivity was inversely associated with subjective pain intensity, and a higher number of baroreflex operations per unit of time predicted higher pain tolerance. Conclusions: The data suggest impaired autonomic cardiovascular regulation in FMS in terms of reduced sympathetic and parasympathetic influences, as well as blunted sympathetic reactivity to acute stress. The association between baroreflex function and pain experience reflects the pain inhibition mediated by the baroreceptor system. Given the reduced baroreflex sensitivity in FMS, one may assume deficient ascending pain inhibition arising from the cardiovascular system, which may contribute to the exaggerated pain sensitivity of FMS. (C) 2011 Elsevier Inc. All rights reserved.