SENSORY TESTING IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN SYNDROMES

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 纤维肌痛是一种慢性肌肉骨骼疼痛疾病，主要困扰女性。频繁伴随的失眠、认知异常和疲劳可能导致早期残疾。到目前为止，这些患者既没有发现软组织异常，也没有发现神经变化。这种疾病的原因不明，没有有效的治疗方法，目前的诊断方法不准确和不可靠。拟议的试点研究将评估定量感觉测试的潜力，通过补充目前手动操作确定的压力点并注意疼痛的存在或不存在来改进对这种疾病的诊断。量化的评估方法包括重复应用简短的、非损伤性的热刺激，这种刺激通常会产生适度的感觉强度的时间总和。患者和正常对照组受试者将用数字标尺对每个刺激引起的迟发性感觉的大小进行口头评分。这项研究的理论基础是，这些患者的慢性疼痛可能是由于供应深层组织的无髓鞘外周传入神经纤维增加了对中枢N-甲基-D-天冬氨酸(NMDA)受体的激活而导致的。如果是这样的话，那么后期热感觉的夸大时间总和应该是明显的，因为它依赖于无髓鞘传入的激活和NMDA受体的刺激。时间总和异常的定量心理物理证据将为未来通过适当给予NMDA拮抗剂进行药物治疗提供理论基础。

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.