SENSORY TESTING IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN SYNDROMES

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。纤维肌痛是一种慢性肌肉骨骼疼痛紊乱，主要折磨女性。经常伴有失眠、认知异常和疲劳可能导致早期残疾。到目前为止，在这些患者中没有发现软组织异常或神经系统改变。这种疾病的病因尚不清楚，没有有效的治疗方法，目前的诊断方法不精确，也不可靠。拟议的试点研究将评估定量感官测试的潜力，通过补充目前用手操作定义的压力点并注意疼痛的存在或不存在的程序来改善这种疾病的诊断。评估的定量方法包括重复应用短暂的、非伤害性的热刺激，通常会产生中等程度的感觉强度的时间总和。病人和正常对照者将口头评价由每个刺激引起的后期感觉的大小，使用数字量表。本研究的理论基础是，这些患者的慢性疼痛可能是由于中央n -甲基- d -天冬氨酸（NMDA）受体的过度激活，这是由于供应深层组织的无髓鞘外周传入神经纤维输入增强的结果。如果是这样的话，那么晚期热感觉的时间累积应该是明显的，因为它依赖于无髓鞘传入神经的激活和NMDA受体的刺激。时间累积异常的定量心理物理证据将为未来适当使用NMDA拮抗剂治疗这种疾病提供理论依据。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Fibromyalgia is a chronic musculoskeletal pain disorder that predominantly afflicts women. Frequently associated insomnia, cognitive abnormalities, and fatigue may lead to early disability. Neither soft tissue abnormalities nor neurological changes have been identified so far in these patients. The cause of this disorder is unknown, no effective treatment is available and the current methods of diagnosis are imprecise and unreliable. The proposed pilot study will evaluate the potential for quantitative sensory testing to improve upon diagnoses of this disorder by supplementing the current procedure of manipulating defined pressure points by hand and noting the presence or absence of pain. The quantitative methods of evaluation involve repetitive application of brief, non-injurious thermal stimulation that normally produces a moderate degree of temporal summation of sensation intensity. The patients and normal control subjects will verbally rate the magnitude of late sensations elicited by each stimulus, using a numerical scale. The theoretical foundation of this study is that chronic pain in these patients may result from exaggerated activation of central N-methyl-D-aspartate (NMDA) receptors as a result of enhanced input from unmyelinated peripheral afferent nerve fibers supplying deep tissues. If this is the case, then exaggerated temporal summation of late thermal sensations should be evident, since it is dependent upon activation of unmyelinated afferents and stimulation of NMDA receptors. Quantitative psychophysical evidence for abnormal temporal summation would provide a rationale for future pharmacological treatment of this condition by suitable administration of NMDA antagonists.