Visceral pain as a triggering factor for fibromyalgia symptoms in comorbid patients
Visceral pain as a triggering factor for fibromyalgia symptoms in comorbid patients
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DOI：
10.1097/j.pain.0000000000000992
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发表时间：
2017-10-01
期刊：
影响因子：
7.4
通讯作者：
Giamberardino, Maria Adele
中科院分区：
文献类型：
--
作者：
Costantini, Raffaele;Affaitati, Giannapia;Giamberardino, Maria Adele
纤维肌痛综合征（FMS）是一种中枢致敏综合征;然而，外周疼痛源可能会加剧其慢性弥漫性肌肉骨骼疼痛和痛觉过敏症状。这项前瞻性研究评价了内脏痛作为共病患者FMS疼痛和痛觉过敏的可能触发因素。患有（1）FMS +肠易激综合征（IBS）的女性;（2）FMS 1原发性痛经（Dys）;（3）FMS +继发于子宫内膜异位症（Endo）的Dys;（4）将FMS 1型结肠憩室病（Div）组与单纯FMS组进行比较，用于纤维肌痛（发作次数和强度以及镇痛剂消耗量）以及躯体痛觉过敏在疼痛（压痛点）和控制区域（阔肌、三角肌、四头肌和覆盖的皮下组织和皮肤）中测量电和压力疼痛阈值。在共病亚组中，在治疗内脏疾病或未治疗后也重新评估FMS症状。所有共病组与仅FMS组相比，在所有部位的深部躯体组织（皮下组织和肌肉）中FMS疼痛（发作次数/强度和镇痛剂消耗）和痛觉过敏显著更高（0.05 < P < 0.0001）。内脏疼痛（IBS天数、疼痛性月经周期和憩室炎引起的腹痛发作）与FMS疼痛的所有参数直接相关，与所有部位的肌肉疼痛阈值呈负相关（0.03 < P < 0.0001）。在内脏共病治疗（饮食6个月[IBS]，激素6个月[痛经]，激光[子宫内膜异位症]和手术[憩室病]）后，所有组织和所有部位的纤维肌痛综合征疼痛和痛觉过敏显著降低（0.05 < P < 0.0001），而未治疗患者无变化。内脏疼痛增强FMS症状，可能增加了该综合征典型的中枢致敏水平。内脏痛合并症的系统评估和治疗应成为FMS管理策略的一部分。
Fibromyalgia syndrome (FMS) is a central sensitization syndrome; however, peripheral pain sources potentially exacerbate its symptoms of chronic diffuse musculoskeletal pain and hyperalgesia. This prospective study evaluated visceral pain as a possible triggering factor for FMS pain and hyperalgesia in comorbid patients. Women with (1) FMS + irritable bowel syndrome (IBS); (2) FMS 1 primary dysmenorrhea (Dys); (3) FMS + Dys secondary to endometriosis (Endo); (4) FMS 1 colon diverticulosis (Div) were compared with FMS-only women, for fibromyalgia pain (number and intensity of episodes and analgesic consumption) over comparable periods and for somatic hyperalgesia (electrical and pressure pain thresholds) in painful (tender points) and control areas (trapezius, deltoid, quadriceps muscles, and overlying subcutis and skin). In comorbid subgroups, FMS symptoms were also reassessed after treatment of the visceral condition or no treatment. All comorbid groups vs FMS-only had significantly higher FMS pain (number/intensity of episodes and analgesic consumption) and hyperalgesia in deep somatic tissues (subcutis and muscle) at all sites (0.05 < P < 0.0001). Visceral pain (number of IBS days, painful menstrual cycles, and abdominal pain episodes from diverticulitis) correlated directly with all parameters of FMS pain and inversely with muscle pain thresholds at all sites (0.03 < P < 0.0001). Fibromyalgia syndrome pain and hyperalgesia in all tissues and all sites significantly decreased in patients after visceral comorbidity treatment (dietary for 6 months [IBS], hormonal for 6 months [dysmenorrhea], laser [endometriosis], and surgery [diverticulosis]) (0.05 < P < 0.0001) vs no change in untreated patients. Visceral pain enhances FMS symptoms, probably augmenting the level of central sensitization typical of the syndrome. Systematic assessment and treatment of visceral pain comorbidities should be a part of FMS management strategy.