Exercise Specificity and Fibromyalgia Pain

摘要 纤维肌痛是一种慢性广泛性疼痛，在中年女性中最常见。锻炼是 为数不多的可以缓解纤维肌痛症状的疗法之一。尽管运动是一个重要组成部分， 在康复的过程中，运动指南不明确，经常导致症状加重和依从性低。 不为人知的运动处方的关键因素包括：1）最有效的运动模式（例如， 静态收缩与动态收缩）; 2）负责缓解疼痛的机制;以及3）生物心理社会影响。 这项研究将运动作为纤维肌痛患者的非药物疼痛管理工具。 我们对运动引起的痛觉减退的理解主要是基于包括高强度 年轻健康男性运动员进行的运动，这不适用于中年女性， 纤维肌痛我们已经表明，纤维肌痛的女性在以下疼痛缓解方面存在相当大的差异： 静态练习我们假设运动后疼痛缓解减弱与异常疼痛有关 涉及下行抑制性疼痛通路的调制。我们对健康成年人的初步数据显示， 具有更有效疼痛调节的个体（即，条件性疼痛调节）报告疼痛缓解更大， 静态练习在健康成人中观察到的这种关系是否仍然存在于纤维肌痛患者中， 知道的本研究将探讨动态与静态疲劳性收缩对疼痛调节的功效 缓解以及与健康成人和纤维肌痛患者的条件性疼痛调制的关系。一是 将确定运动引起的疼痛缓解是否取决于运动收缩的类型， 没有纤维肌痛。实验和临床疼痛报告将比较之前和之后的表现 在相同的相对强度下，在次最大负荷下进行动态和间歇性静态收缩。 其次，我们将确定条件性疼痛调制是否预测运动引起的疼痛缓解。 实验性疼痛报告将在有和没有有害刺激的情况下测量（即，冰水浴）作为 测量条件性疼痛调制。我们假设：1）纤维肌痛患者会表现出 与无纤维肌痛的人相比，运动引起的疼痛缓解减弱且变化更大; 2）疼痛 缓解将更大的动态运动后比静态运动;和3）条件性疼痛调制将 与运动后疼痛缓解的程度相关，纤维肌痛患者的疼痛缓解程度较低。 该项目还将调查几个生物心理社会因素（体力活动水平，疼痛灾难化， 和恐惧回避行为），可能有助于疼痛感知，运动缓解疼痛， 疼痛调节生物心理社会属性的纳入促进了以人为本的方法， 解决纤维肌痛的异质性，同时确定将受益的纤维肌痛患者的概况 大部分来自锻炼。成功完成将建立必要的原则，创造临床实践 运动作为一种有效的疼痛管理工具和生物心理社会对这种反应的影响。

ABSTRACT Fibromyalgia is a chronic widespread pain condition that is most prevalent in middle-aged women. Exercise is one of the few therapies that can alleviate fibromyalgia symptoms. Despite exercise being a major component of rehabilitation, exercise guidelines are unclear, often leading to symptom exacerbation and low compliance. Factors critical to exercise prescription that are not known include: 1) the most effective mode of exercise (e.g., static vs. dynamic contractions); 2) mechanisms responsible for pain relief; and 3) biopsychosocial influences. This study addresses exercise as a nonpharmacological pain management tool for people with fibromyalgia. Our understanding of exercise-induced hypoalgesia is primarily based on studies that include high-intensity exercise performed by young healthy male athletes, which is not applicable to the middle-aged woman with fibromyalgia. We have shown that women with fibromyalgia have considerable variability in pain relief following static exercise. We hypothesize that the attenuated pain relief following exercise is related to abnormal pain modulation involving descending inhibitory pain pathways. Our preliminary data with healthy adults shows that individuals with more efficient pain modulation (i.e., conditioned pain modulation) report greater pain relief with static exercise. Whether this relation observed in healthy adults remains in those with fibromyalgia is not known. This proposal will explore the efficacy of dynamic and static fatiguing contractions in modulating pain relief and the relation to conditioned pain modulation in healthy adults and people with fibromyalgia. First, we will establish if exercise-induced pain relief is dependent on the type of exercise contraction in people with and without fibromyalgia. Experimental and clinical pain reports will be compared before and after the performance of dynamic and intermittent static contractions at submaximal loads performed at the same relative intensity. Second, we will determine whether conditioned pain modulation predicts exercise-induced pain relief. Experimental pain reports will be measured with and without a noxious stimulus (i.e., ice water bath) as a measurement of conditioned pain modulation. We hypothesize: 1) people with fibromyalgia will exhibit attenuated and more variable exercise-induced pain relief compared with people without fibromyalgia; 2) pain relief will be greater following dynamic exercise than static exercise; and 3) conditioned pain modulation will be associated with the magnitude of pain relief following exercise, which will be less in people with fibromyalgia. This project will also investigate several biopsychosocial factors (physical activity levels, pain catastrophizing, and fear avoidance behaviors) that may contribute to pain perception, pain relief with exercise, and conditioned pain modulation. The incorporation of biopsychosocial attributes promotes a person-centered approach to address the heterogeneity in fibromyalgia while identifying profiles of people with fibromyalgia who will benefit most from exercise. Successful completion will establish principles necessary to create clinical practice paradigms for exercise as an effective pain management tool and biopsychosocial influences on this response.