SENSORY TESTING IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN SYNDROMES

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心机构，不一定是研究者机构。纤维肌痛是一种慢性肌肉骨骼疼痛疾病，主要困扰妇女。频繁相关的失眠、认知异常和疲劳可能导致早期残疾。到目前为止，在这些患者中尚未发现软组织异常或神经系统变化。这种疾病的原因是未知的，没有有效的治疗方法，目前的诊断方法是不准确和不可靠的。拟议的试点研究将评估定量感觉测试的潜力，以改善这种疾病的诊断，通过补充目前的程序，用手操作定义的压力点，并注意到疼痛的存在或不存在。定量评估方法包括重复应用短暂的、非损伤性的热刺激，通常会产生中等程度的感觉强度的时间总和。患者和正常对照受试者将使用数字量表口头评定每个刺激引起的迟发感觉的大小。本研究的理论基础是，这些患者的慢性疼痛可能是由于中枢N-甲基-D-天冬氨酸（NMDA）受体的过度激活，这是由于无髓外周传入神经纤维供应深部组织的输入增强所致。如果是这样的话，那么晚期热感觉的夸大的时间总和应该是明显的，因为它依赖于无髓鞘传入神经的激活和NMDA受体的刺激。定量的心理物理证据异常的时间总和将提供一个合理的未来药物治疗这种情况下，适当的管理NMDA拮抗剂。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Fibromyalgia is a chronic musculoskeletal pain disorder that predominantly afflicts women. Frequently associated insomnia, cognitive abnormalities, and fatigue may lead to early disability. Neither soft tissue abnormalities nor neurological changes have been identified so far in these patients. The cause of this disorder is unknown, no effective treatment is available and the current methods of diagnosis are imprecise and unreliable. The proposed pilot study will evaluate the potential for quantitative sensory testing to improve upon diagnoses of this disorder by supplementing the current procedure of manipulating defined pressure points by hand and noting the presence or absence of pain. The quantitative methods of evaluation involve repetitive application of brief, non-injurious thermal stimulation that normally produces a moderate degree of temporal summation of sensation intensity. The patients and normal control subjects will verbally rate the magnitude of late sensations elicited by each stimulus, using a numerical scale. The theoretical foundation of this study is that chronic pain in these patients may result from exaggerated activation of central N-methyl-D-aspartate (NMDA) receptors as a result of enhanced input from unmyelinated peripheral afferent nerve fibers supplying deep tissues. If this is the case, then exaggerated temporal summation of late thermal sensations should be evident, since it is dependent upon activation of unmyelinated afferents and stimulation of NMDA receptors. Quantitative psychophysical evidence for abnormal temporal summation would provide a rationale for future pharmacological treatment of this condition by suitable administration of NMDA antagonists.