Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia
Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia
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DOI：
10.1097/j.pain.0000000000000777
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发表时间：
2017-03-01
期刊：
影响因子：
7.4
通讯作者：
Tesarz, Jonas
中科院分区：
文献类型：
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作者：
Gerhardt, Andreas;Eich, Wolfgang;Tesarz, Jonas
在慢性背痛（CBP）中考虑条件性疼痛调制（CPM）的发现是矛盾的。这可能是因为许多CBP患者报告身体其他部位疼痛，CPM改变可能影响疼痛的空间范围，而不是CBP本身。因此，我们比较了不同疼痛程度的CBP患者的CPM。纤维肌痛综合征（FMS）患者，其中CPM损害的报告最一致，进行了测量比较。根据临床评价和疼痛图，将患者分为慢性局部背痛（CLP; n = 53）、慢性广泛性背痛（CWP; n = 32）和FMS（n = 92）。通过强直性热痛（条件刺激）之前和之后下背部的压力痛阈值（测试刺激）的差异来测量条件性疼痛调制。我们还测量了心理社会变量。CLP患者热痛后压痛阈值明显升高（P < 0.001），提示CPM的诱发。CLP组的条件性疼痛调制显著高于CWP组和FMS组（P < 0.001），但CWP组和FMS组的CPM无显著差异。有趣的是，在CBP中，更多的疼痛区域（0-10）与较低的CPM相关（r = 0.346，P = 0.001），但在FMS中则无关（r = 20.013，P = 0.903）。FMS患者的焦虑、抑郁情绪较CLP、CWP患者明显（P值均<0.05
Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPMmight influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P < 0.001) indicating induction of CPM. Conditioned pain modulation in CLP was significantly higher than that in CWP and FMS (P < 0.001), but CPM in CWP and FMS did not differ. Interestingly, a higher number of painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = 20.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP orCWP(P values