Neurophysiologic evidence for a central sensitization in patients with fibromyalgia
Neurophysiologic evidence for a central sensitization in patients with fibromyalgia
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DOI：
10.1002/art.10893
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发表时间：
2003-05-01
影响因子：
--
通讯作者：
Vischer, TL
中科院分区：
文献类型：
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作者：
Desmeules, JA;Cedraschi, C;Vischer, TL
Objective.通过定量感觉测试（QST）和独立于主观报告的神经生理学范式，确定纤维肌痛（FM）患者与对照组相比，在自发性疼痛区域之外是否存在外周和中枢伤害性感觉输入处理的异常。共有164名FM门诊患者参加了自我管理计划，被邀请参加这项研究。85例患者的数据可用，并与40名年龄和性别匹配的非FM对照进行比较。在非自发性疼痛的位置使用热、机械和电刺激进行QST。疼痛评估为2倍，包括使用主观量表和脊髓伤害性屈曲反射（NFR），这是一种与中枢伤害性通路客观评价相关的特定生理学指标。关于生活质量和FM的影响的问卷是可用的。参与者主要是中年女性，平均病程为8年。组间差异在神经生理学、临床和生活质量指标方面具有显著性。在FM患者中，外周QST显示冷痛和热痛阈值显著改变，对冷痛的耐受性从根本上降低。FM患者的中位NFR阈值（22.7 mA [范围17.5-31.7]）与对照组（33 mA [范围28.1-41]）相比显著降低。的截止值
Objective. To determine whether abnormalities of peripheral and central nociceptive sensory input processing exist outside areas of spontaneous pain in patients with fibromyalgia (FM) as compared with controls, by using quantitative sensory testing (QST) and a neurophysiologic paradigm independent from subjective reports.Methods. A total of 164 outpatients with FM who were attending a self-management program were invited to participate in the study. Data for 85 patients were available and were compared with those for 40 non-FM controls matched for age,and sex. QST was performed using thermal, mechanical, and electrical stimuli at locations of nonspontaneous pain. Pain assessment was 2-fold and included use of subjective scales and the spinal nociceptive flexion reflex (NFR), a specific physiologic correlate for the objective evaluation of central nociceptive pathways. Questionnaires regarding quality of life and the impact of FM were available.Results. Participants were mainly middle-aged women, with a mean disease duration of 8 years. Between-group differences were significant for neurophysiologic, clinical, and quality of life measures. In patients with FM, peripheral QST showed significantly altered cold and heat pain thresholds, and tolerance to cold pain was radically reduced. The median NFR threshold in patients with FM (22.7 mA [range 17.5-31.7]) was significantly decreased compared with that in controls (33 mA [range 28.1-41]). A cutoff value of