University of Michigan Fibromyalgia CORT

项目总结/摘要 总体组件 慢性肌肉骨骼疼痛是非常常见的，疼痛是最常见的症状，在几乎所有 风湿性疾病然而，在所有慢性疼痛状况中， 外周可识别的损伤/炎症-和疼痛，以及经典的心理因素，如情绪 或灾难性的解释很少疼痛和客观结果之间的差异。许多人与 慢性疼痛有手术治疗这个问题，并持续疼痛，尽管手术效果很好，正如 许多患有自身免疫性疾病的患者在炎症得到良好控制后仍有疼痛， 生物制剂 我们假设，疼痛和其他症状之间存在如此差异的原因是， 外周损伤/炎症程度-慢性肌肉骨骼疼痛患者表现为 不同程度的纤维肌痛密歇根大学纤维肌痛CORT提出，目前 2011年FM调查标准是集中性疼痛的替代指标， 将预示更多的疼痛和其他源自中枢神经系统（CNS）的症状。因此 该测量的较高分数将使个体对旨在 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 表型对FM具有刻板的临床和神经生物学特征，即使当它与其他表型共病时也是如此。 具有不同潜在疼痛机制的肌肉骨骼疼痛状况：骨关节炎、类风湿性关节炎 关节炎和腕管综合症 我们的具体目标是：1）证明目前的2011年FM调查标准是一个强大的 疼痛集中替代物和对通常有效的治疗的强烈预测无反应性， 治疗外周疼痛，包括a）旨在缓解疼痛的手术（髋关节成形术、腕管综合征 释放），B）施用生物剂以治疗自身免疫性疾病（类风湿性关节炎），和c） 阿片类药物的急性围手术期给药; 2）为了证明在所有三个队列中， 最高的FM评分将具有类似的神经生物学结果，即疼痛集中在定量感觉上， 测试（QST）和神经影像学; 3）开发和试点测试更短，更有预测性的自我报告 疼痛集中的测量; 4）探讨两个重要子集的临床和机制特征， 集中性疼痛：自上而下（即先前称为原发性FM）与自下而上（即先前称为继发性FM） FM）; 5）作为培训研究人员和临床医生的核心国家资源， 肌肉骨骼疼痛研究和护理。

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.