University of Michigan Fibromyalgia CORT

项目摘要/摘要 整体组件 慢性肌肉骨骼疼痛极为常见，疼痛是几乎所有疼痛中最常见的症状。 风湿性疾病。然而，在所有慢性疼痛情况下， 可识别的外周损伤/炎症--以及疼痛，以及情绪等经典心理因素 或者说，灾难对疼痛和客观结果之间的差异解释很少。许多人患有 慢性疼痛有手术治疗这个问题，尽管手术效果很好，但仍持续疼痛，就像 许多自身免疫性疾病的患者在炎症得到很好的控制后仍有疼痛。 生物制品。 我们假设，疼痛和其他症状之间存在如此差异的原因--以及 外周损伤/炎症的程度-慢性肌肉骨骼疼痛的个体表现 不同程度的纤维肌痛。密歇根大学纤维肌痛研究中心提出，目前的 2011年FM调查标准是集中化疼痛的替代衡量标准，这一衡量标准的得分更高 将预示着更多的疼痛和其他源于中枢神经系统(CNS)的症状。因此， 在这项测试中得分较高的人会对针对以下目标的止痛疗法反应较差 外周/伤害性疼痛(手术、生物制剂、阿片类药物)。我们将证明这种集中的痛苦 表型具有典型的FM的临床和神经生物学特征，即使当它与其他 具有不同潜在疼痛机制的肌肉骨骼疼痛状况：骨关节炎、类风湿 关节炎和腕管综合症。 我们的具体目标是：1)证明当前的2011年调频调查标准是一个强有力的 疼痛集中的替代物和强烈预测对治疗通常有效的无反应 治疗外周疼痛，包括a)旨在缓解疼痛的手术(髋关节置换术、腕管 释放)，b)生物制剂治疗自身免疫性疾病(类风湿性关节炎)，以及c) 阿片类药物的急性围术期应用；2)证明在所有三个队列中，患有阿片类药物的个体 FM得分最高的人在定量感觉上的疼痛集中的神经生物学结果相似 测试(QST)和神经成像；3)开发和试行更短、更具预测性的自我报告 疼痛集中的测量；4)探讨疼痛集中的两个重要亚群的临床和机制特征 集中性疼痛：自上而下(即以前称为初级FM)与自下而上(即以前称为继发性) Fm)；以及5)作为培训当代研究人员和临床医生的核心国家资源 肌肉骨骼疼痛的研究和护理。

PROJECT SUMMARY / ABSTRACT OVERALL COMPONENT Chronic musculoskeletal pain is extremely common, and pain is the most common symptom in nearly all rheumatic disorders. However, in all chronic pain conditions there is a tremendous disparity between identifiable damage/inflammation in the periphery – and pain, and classic psychological factors such as mood or catastrophizing explain very little of the variance between pain and objective findings. Many individuals with chronic pain have surgery for this problem and have continued pain despite excellent surgical results, just as many patients with autoimmune disorders continue to have pain after inflammation is well controlled with biologics. We hypothesize that the reason there is such a disparity between pain and other symptoms - and the degree of damage/inflammation in the periphery - is that individuals with chronic musculoskeletal pain display variable degrees of fibromyalgia. The University of Michigan Fibromyalgia CORT proposes that the current 2011 FM Survey Criteria is a surrogate measure of centralized pain, and that higher scores on this measure will be predictive of more pain and other symptoms originating from the central nervous system (CNS). Thus higher scores on this measure will render individuals less responsive to analgesic therapies aimed at peripheral/nociceptive pain (surgery, biologics, opioids). We will demonstrate that this centralized pain phenotype has stereotypical clinical and neurobiological features to FM even when it is co-morbid with other musculoskeletal pain conditions with disparate underlying pain mechanisms: osteoarthritis, rheumatoid arthritis, and carpal tunnel syndrome. Our specific aims are: 1) To demonstrate that the current 2011 FM Survey Criteria serve as a strong surrogate of pain centralization and strongly predict non-responsiveness to therapies generally effective for treating peripherally-based pain, including a) surgery intended to relieve pain (hip arthroplasty, carpal tunnel release), b) administration of a biologic agent to treat an autoimmune disorder (rheumatoid arthritis), and c) acute perioperative administration of opioids; 2) To demonstrate that in all three cohorts individuals with the highest FM scores will have similar neurobiological findings of pain centralization on quantitative sensory testing (QST) and neuroimaging; 3) To develop and pilot test a shorter and more predictive self-report measure of pain centralization; 4) To explore the clinical and mechanistic features of two important subsets of centralized pain: top-down (i.e. previously termed primary FM) vs. bottom-up (i.e. previously termed secondary FM); and 5) To serve as a core national resource for training both researchers and clinicians in contemporary musculoskeletal pain research and care.