Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients
Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients
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DOI：
10.1016/s0304-3959(02)00053-2
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发表时间：
2002-09-01
期刊：
影响因子：
7.4
通讯作者：
Vierck, CJ
中科院分区：
文献类型：
--
作者：
Price, DD;Staud, R;Vierck, CJ
我们以前已经表明，纤维肌痛（FMS）患者有增强的时间总和（windup）和延长衰减的热诱导的第二次疼痛相比，对照组，符合中央敏化。有人假设FMS患者的感觉异常与疼痛调节机制缺陷有关。因此，我们进行了几项分析，以进一步表征FMS患者增强的卷起，并确定其是否可以通过安慰剂、纳洛酮或芬太尼进行中枢调节。比较FMS和正常对照（NC）组的给药前基线评级，以确定FMS是否对主要用于激活A-δ热、C热或冷伤害感受器的几种类型的热测试具有更高的疼痛敏感性。我们的研究结果证实并扩展了我们早期的研究，即与年龄和性别匹配的NC受试者相比，FMS患者具有更大幅度的热敲击以及冷敲击诱导的发条。这两组在主要依赖A-δ伤害性传入输入的感觉测试中的评分差异较小。热和冷诱导的发条减弱生理盐水安慰剂注射和芬太尼（0.75和1.5。μ g/kg）。然而，纳洛酮注射液对第一次或第二次疼痛的影响程度与安慰剂注射液相同。与NC受试者相比，生理盐水安慰剂和芬太尼在FMS中对发条的镇痛作用至少与NC受试者一样大，因此不支持FMS中疼痛调节机制缺陷的假设。在一定程度上，时间总和的第二次疼痛（windup）有助于潜在的痛觉过敏和持续性疼痛状态的过程中，这些结果间接表明，这些过程可以集中调制FMS患者的内源性和外源性镇痛操作。(C)2002年国际疼痛研究协会。由Elsevier Science B. V.出版，版权所有。
We have previously shown that fibromyalgia (FMS) patients have enhanced temporal summation (windup) and prolonged decay of heat-induced second pain in comparison to control subjects, consistent with central sensitization. It has been hypothesized that sensory abnormalities of FMS patients are related to deficient pain modulatory mechanisms. Therefore, we conducted several analyses to further characterize enhanced windup in FMS patients and to determine whether it can be centrally modulated by placebo, naloxone, or fentanyl. Pre-drug baseline ratings of FMS and normal control (NC) groups were compared with determine whether FMS had higher pain sensitivity in response to several types of thermal tests used to predominantly activate A-delta heat, C heat, or cold nociceptors. Our results confirmed and extended our earlier study in showing that FMS patients had larger magnitudes of heat tap as well as cold tap-induced windup when compared with age- and sex-matched NC subjects. The groups differed less in their ratings of sensory tests that rely predominantly on A-delta-nociceptive afferent input. Heat and cold-induced windup were attenuated by saline placebo injections and by fentanyl (0.75 and 1.5. mug/kg). However, naloxone injection had the same magnitudes of effect on first or second pain as that produced by placebo injection. Hypoalgesic effects of saline placebo and fentanyl on windup were at least as large in FMS as compared to NC subjects and therefore do not support the hypothesis that pain modulatory mechanisms are deficient in FMS. To the extent that temporal summation of second pain (windup) contributes to processes underlying hyperalgesia and persistent pain states, these results indirectly suggest that these processes can be centrally modulated in FMS patients by endogenous and exogenous analgesic manipulations. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.