AUTONOMIC STRESS REACTIVITY IN FIBROMYALGIA

这是一项R21申请，旨在初步研究纤维肌痛综合征（FMS）患者自主神经应激反应性与疼痛敏感性的关系。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疼痛调节失调的疾病。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，压力加剧了他们的疼痛和症状。研究表明FMS中存在自主神经失调。FMS患者往往表现出迟钝的自主反应噪音，寒冷，和物理应激源。心血管疾病和头痛疾病的研究，以及动物/人类实验室研究，已经证明了觉醒增加的抗痛觉作用，特别是压力反射和幽闭交感反应。这些先前的报告表明，应激反应中失调的自主神经功能在疼痛敏感性升高和其他FMS症状中起重要作用。在我们提出的研究中，我们假设1)FMS与交感神经反应迟钝有关，2)FMS与直立不耐受的易感性增加有关，3)应激性镇痛药在FMS中被最小化。将30例FMS患者、30例颞下颌紊乱（TMD：局域疼痛控制）患者和30例无痛健康人分别进行各种应激任务、直立耐力测试和疼痛敏感性测试，同时连续测量血压和瞳孔大小。与任务相关的压力水平相对适中（心算，讨论压力经验），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，本研究的结果应该为应激诱导的自主神经异常对FMS症状的影响提供初步证据。此外，该研究结果可能为改善自主神经功能障碍继发症状提供重要途径。

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.