Assessment of psychological distress in fibromyalgia

纤维肌痛患者疼痛阈值降低和疼痛耐受性降低的基础仍有待澄清。除了生物学变量，如性别，中枢致敏，“风”（异常的时间总和疼痛），和中央失调的几个轴的压力反应，认知，行为，情绪，环境和文化变量似乎有助于重要的慢性疼痛的经验和相关的神经病学在这种疾病。在这方面，将生物和心理社会因素联系起来的一个共同点可能是心理困扰。申请人的初步数据为 这与以下假设一致：心理痛苦降低了痛阈，因此导致了纤维肌痛中广泛的异常性疼痛和痛觉过敏。本提案的直接目标是使用来自纤维肌痛和其他风湿性疾病患者队列的已建立数据库，以确定慢性广泛性疼痛发展和持续的一些个体差异。这将是完成 通过以下具体目的：目的1，使用热和缺血性疼痛技术确定心理困扰与疼痛阈值和耐受性的关联;目的2， 确定无助、乐观和悲观是否与纤维肌痛和其他风湿性疾病患者的自我报告疼痛、压痛阈值和痛苦的定义模式相关;目标3，为了确定我们的初步数据是否显示了纤维肌痛和其他风湿性疾病患者在学术医疗中心接受治疗时的痛苦和压力疼痛阈值的反比关系，社会各界目的3将使我们能够通过比较关节炎临床数据库来确定我们初步数据的普遍性，该数据库包括通过完成自我报告问卷、活动和生活方式指数以及通过痛觉测量法在4个纤维肌痛压痛点和NC获得的连续患者的信息。 风湿病学家数据库也基于北卡罗来纳州私人执业的风湿病学家的患者完成的活动和生活方式指数;此外，还收集了关于心理困扰和压力疼痛阈值之间关系的横截面数据， 在NC风湿病学家的护理下，将在患有纤维肌痛和其他诊断的患者亚组中获得痛觉测量。

The bases for the decreased pain threshold and pain tolerance that is characteristic of people with fibromyalgia remain to be clarified. In addition to biological variables, such as gender, central sensitization, "wind-up" (abnormal temporal summation of pain), and central dysregulation of several axes of the stress response, cognitive, behavioral, emotional, environmental, and cultural variables appear to contribute importantly to the chronic pain experience and associated symptomatology in this disorder. A common denominator linking both biological and psychosocial contributors in this regard may be psychologic distress. The applicant's preliminary data are consistent with the hypothesis that psychological distress lowers pain threshold and, therefore, contributes to widespread allodynia and hyperalgesia in fibromyalgia. The immediate objective of this proposal is to use established databases from a cohort of patients with fibromyalgia and other rheumatologic conditions to define some of the individual differences that underlie the development and perpetuation of chronic widespread pain. This will be accomplished through the following Specific Aims: Aim 1, to determine the association of psychological distress with pain threshold and tolerance using thermal and ischemic pain techniques; Aim 2, to determine whether helplessness, optimism, and pessimism are associated with defined patterns of self-reported pain, pressure pain threshold and distress in patients with fibromyalgia and other rheumatologic disorders; and Aim 3, to determine whether our preliminary data showing an inverse relationship of distress and pressure pain threshold in fibromyalgia and other rheumatic disease patients receiving care in an academic medical center also obtain for patients in the community. Aim 3 will allow us to determine the generalizability of our preliminary data through comparisons of the UNC Arthritis Clinic Database, which consists of information on consecutive patients obtained from completion of a self-report questionnaire, Activities and Lifestyle Index and pressure pain threshold by algometry at 4 fibromyalgia tender points and the NC Rheumatologists Database also based on the Activities and Lifestyle Index completed by patients of rheumatologists in private practice in North Carolina; in addition, cross-sectional - data concerning the relationship of psychological distress and pressure pain threshold by algometry will be obtained in a subset of patients with fibromyalgia and other diagnoses under the care of NC rheumatologists.