Characterization and consequences of pain variability in individuals with fibromyalgia
Characterization and consequences of pain variability in individuals with fibromyalgia
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DOI：
10.1002/art.21407
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发表时间：
2005-11-01
影响因子：
--
通讯作者：
Clauw, DJ
中科院分区：
文献类型：
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作者：
Harris, RE;Williams, DA;Clauw, DJ
Objective.越来越多的证据表明，对疼痛的实时电子评估比传统的纸笔测量更可取。我们使用来自纤维肌痛（FM）患者的研究的电子评估数据，以检查随着时间的推移疼痛的变化，并在临床试验的背景下调查疼痛波动的影响。研究组包括125名FM患者，他们参加了一项随机、安慰剂对照的米那普仑试验。参与者使用电子日记以真实的时间记录疼痛强度水平。疼痛的变异性被评估为疼痛条目随时间的标准差（疼痛变异性指数[PVI]）。观察到受试者间疼痛变异性存在显著差异（平均值+/- SD PVI 1.61 +/- 0.656 [范围0.27-4.05]）。疼痛报告的波动在个体内是恒定的（r = 0.664，P < 0.001）。在药物试验中，变异性较大的个体更可能被归类为应答者（优势比6.14，P = 0.006）;然而，这种关联主要归因于接受安慰剂的个体（r = 0.460，P = 0.02）比接受活性药物的个体（r = 0.09，P > 0.10）疼痛评分变化更大。在FM患者中，实时疼痛报告存在较大的受试者间差异。疼痛的变异性是相对恒定的，随着时间的推移，在个人。也许最重要的发现是，疼痛波动较大的个体更有可能对安慰剂产生反应。目前尚不清楚这些发现是否仅适用于FM患者，或者是否也适用于其他慢性疼痛患者。
Objective. A growing body of evidence suggests that real-time electronic assessments of pain are preferable to traditional paper-and-pencil measures. We used electronic assessment data derived from a study of patients with fibromyalgia (FM) to examine variability of pain over time and to investigate the implications of pain fluctuation in the context of a clinical trial.Methods. The study group comprised 125 patients with FM who were enrolled in a randomized, placebo-controlled trial of milnacipran. Pain intensity levels were captured in real time by participants using electronic diaries. Variability in pain was assessed as the standard deviation of pain entries over time (pain variability index [PVI]).Results. Substantial between-subject differences in pain variability were observed (mean +/- SD PVI 1.61 +/- 0.656 [range 0.27-4.05]). The fluctuation in pain report was constant over time within individuals (r = 0.664, P < 0.001). Individuals with greater variability were more likely to be classified as responders in a drug trial (odds ratio 6.14, P = 0.006); however, this association was primarily attributable to a greater change in pain scores in individuals receiving placebo (r = 0.460, P = 0.02) rather than active drug (r = 0.09, P > 0.10).Conclusion. Among individuals with FM, there were large between-subject differences in real-time pain reports. Pain variability was relatively constant over time within individuals. Perhaps the most important finding is that individuals with larger pain fluctuations were more likely to respond to placebo. It is not clear whether these findings are applicable only to patients with FM or whether they may also be seen in patients with other chronic pain conditions.