AUTONOMIC STRESS REACTIVITY IN FIBROMYALGIA

这是一项R21申请，旨在对纤维肌痛综合征（FMS）患者的自主神经应激反应性和疼痛敏感性之间的关系进行初步研究。虽然FMS的确切病理生理机制尚未确定，但FMS通常被认为是一种涉及中枢疼痛调节失调的疾病。 此外，FMS似乎与应激适应功能障碍有关。许多FMS患者报告说，压力加剧了他们的疼痛和症状。 研究表明FMS存在自主神经功能失调。 FMS患者往往表现出迟钝的自主反应，噪音，寒冷，和身体的压力。 对心血管和头痛疾病的研究以及动物/人类实验室研究已经证明了唤醒增加的抗伤害感受作用，特别是压力反射和职业交感神经反应性。 这些先前的报告表明，失调的自主神经功能，以应对压力发挥了重要作用，在疼痛敏感性和其他FMS症状的升高。 在拟议的研究中，我们假设1）FMS与交感神经反应性减弱有关，2）FMS与发生直立不耐受的易感性增加有关，3）FMS中应激诱导的镇痛药最小化。 30名FMS患者、30名颞下颌关节紊乱病（TMD：局部疼痛控制）患者和无疼痛的健康受试者将接受各种应激任务、立位耐力测试和疼痛敏感性测试，同时连续测量血压和瞳孔大小。 与任务相关的压力水平相对适中（心算，讨论压力体验），从而使我们能够确定患者报告的日常压力源的重要性作为加重因素。 因此，这项研究的结果应提供初步证据的影响，应激诱导的自主神经功能障碍的FMS症状。 此外，该研究的结果可能为改善继发于自主神经功能障碍的症状提供了重要途径。

This is an R21 application proposing to conduct a preliminary study on the relationship between autonomic stress-reactivity and pain sensitivity in patients with fibromyalgia syndrome (FMS). Although the exact pathphysiologic mechanisms of FMS are yet to be determined, FMS is generally considered as a disorder involving dysregulated central pain modulation. In addition, FMS seems to be associated with dysfunctional stress adaptation. Many FMS patients report that stress exacerbates their pain and symptoms. Research has suggested that autonomic dysregulation exists in FMS. FMS patients tend to exhibited blunted autonomic reactivity to noise, cold, and physical stressors. Research in cardiovascular and headache disorders, as well as animal/human laboratory studies, have demonstrated the antinociceptive effects of increased arousal, particularly baroreflex and occulosympathetic reactivity. These previous reports suggest that dysregulated autonomic functions in response to stressors play an important role in elevated pain sensitivity and other FMS symptoms. In the proposed study, we hypothesize that 1) FMS is associated with blunted sympathetic reactivity, 2) FMS is related to increased susceptibility to develop orthostatic intolerance, and 3) stress-induced analgesics are minimized in FMS. 30 FMS patients, 30 patients with temporomandibular disorder (TMD: localized pain control), and pain-free healthy subjects will undergo various stress tasks, orthostatic torelance test, and pain sensitivity test while blood pressure and pupil size are continuously measured. The levels of stress associated with tasks are relatively moderate (mental arithmetic, discussion of stressful experience), thereby allowing us to determine the importance of daily stressors patients report as an aggravating factor. Results from this study thus should provide initial evidence regarding the effects of stress-induced dysautonomia in FMS symptoms. Furthermore, the results of the study may provide an important avenue for improving those symptoms secondary to autonomic dysfunction.