AUTONOMIC STRESS REACTIVITY IN FIBROMYALGIA

这是一项R21应用，旨在对纤维肌痛综合征(FMS)患者自主神经应激反应与疼痛敏感性之间的关系进行初步研究。虽然FMS的确切病理生理机制尚未确定，但FMS通常被认为是一种涉及中枢痛觉调制失调的疾病。此外，FMS似乎与功能失调的压力适应有关。许多FMS患者报告说，压力会加剧他们的疼痛和症状。研究表明，FMS存在自主神经失调。FMS患者往往对噪音、寒冷和身体应激源表现出迟钝的自主神经反应。对心血管和头痛障碍的研究，以及动物/人类的实验室研究，都证明了增强的觉醒，特别是压力反射和隐蔽交感反应的抗伤害效应。这些先前的报告表明，对应激源反应的自主神经功能失调在疼痛敏感性升高和其他FMS症状中起着重要作用。在拟议的研究中，我们假设1)FMS与钝化的交感反应有关，2)FMS与发生立位不耐受的易感性增加有关，以及3)FMS中应激诱导的镇痛剂最少。30例FMS患者、30例颞下颌关节紊乱病(TMD：局部性疼痛控制)患者和无疼痛健康受试者在连续测量血压和瞳孔大小的同时，进行各种应激任务、立位耐力测试和疼痛敏感性测试。与任务相关的压力水平相对适中(心算、对压力经历的讨论)，从而使我们能够确定患者报告的日常压力源作为加重因素的重要性。因此，这项研究的结果应该为应激诱导的自主神经障碍在FMS症状中的影响提供初步证据。此外，研究结果可能为改善继发于自主神经功能障碍的症状提供重要途径。

This is an R21 application proposing to conduct a preliminary study on the relationship between autonomic stress-reactivity and pain sensitivity in patients with fibromyalgia syndrome (FMS). Although the exact pathphysiologic mechanisms of FMS are yet to be determined, FMS is generally considered as a disorder involving dysregulated central pain modulation. In addition, FMS seems to be associated with dysfunctional stress adaptation. Many FMS patients report that stress exacerbates their pain and symptoms. Research has suggested that autonomic dysregulation exists in FMS. FMS patients tend to exhibited blunted autonomic reactivity to noise, cold, and physical stressors. Research in cardiovascular and headache disorders, as well as animal/human laboratory studies, have demonstrated the antinociceptive effects of increased arousal, particularly baroreflex and occulosympathetic reactivity. These previous reports suggest that dysregulated autonomic functions in response to stressors play an important role in elevated pain sensitivity and other FMS symptoms. In the proposed study, we hypothesize that 1) FMS is associated with blunted sympathetic reactivity, 2) FMS is related to increased susceptibility to develop orthostatic intolerance, and 3) stress-induced analgesics are minimized in FMS. 30 FMS patients, 30 patients with temporomandibular disorder (TMD: localized pain control), and pain-free healthy subjects will undergo various stress tasks, orthostatic torelance test, and pain sensitivity test while blood pressure and pupil size are continuously measured. The levels of stress associated with tasks are relatively moderate (mental arithmetic, discussion of stressful experience), thereby allowing us to determine the importance of daily stressors patients report as an aggravating factor. Results from this study thus should provide initial evidence regarding the effects of stress-induced dysautonomia in FMS symptoms. Furthermore, the results of the study may provide an important avenue for improving those symptoms secondary to autonomic dysfunction.