PDF(Pubmed)
Abstract：
Fibromyalgia (FM) is a widespread chronic pain syndrome, possibly associated with the presence of central dysfunction in descending pain inhibition pathways. Conditioned Pain Modulation (CPM) has been proposed as a biomarker of FM. Nonetheless, the wide variety of methods used to measure CPM has hampered robust conclusions being reached. To clarify the validity of CPM as a biomarker of FM, we tested two CPM paradigms (parallel and sequential) in a sample of 23 female patients and 23 healthy women by applying test (mechanical) stimuli and conditioning (pressure cuff) stimuli. We evaluated whether CPM indices could correctly classify patients and controls, and we also determined the correlations between the indices and clinical variables such as symptomatology, disease impact, depression, quality of life, pain intensity, pain interference, fatigue and numbness. In addition, we compared the clinical status of CPM responders (efficient pain inhibitory mechanism) and non-responders. We observed that only parallel CPM testing correctly classified about 70% of patients with FM. In addition, more than 80% of healthy participants were found to be responders, while the rate was about 50% in the FM patients. The sequential CPM test was not as sensitive, with a decrease of up to 40% in the response rate for both groups. On the other hand, we did not observe any correlation between CPM measures and clinical symptoms. In summary, our findings demonstrate the influence of the CPM paradigm used and confirm that CPM may be a useful marker to complement FM diagnosis. However, the findings also cast doubts on the sensitivity of CPM as a marker of pain severity in FM.
摘要：
纤维肌痛（FM）是一种广泛的慢性疼痛综合征，可能与下降疼痛抑制途径中中枢功能障碍的存在有关。条件性疼痛调节(CPM)已被提出作为FM的生物标志物。尽管如此，用于测量CPM的各种方法阻碍了得出可靠的结论。为了阐明CPM作为FM生物标志物的有效性，我们通过施加测试(机械)刺激和调节(压力袖带)刺激,在23名女性患者和23名健康女性的样本中测试了两种CPM范例(并行和序贯).我们评估了CPM指数是否可以正确分类患者和对照组，我们还确定了指标与临床变量之间的相关性，例如症状学，疾病影响,抑郁症,生活质量,疼痛强度，疼痛干扰，疲劳和麻木。此外,我们比较了CPM应答者(有效的疼痛抑制机制)和非应答者的临床状况.我们观察到，只有平行的CPM测试正确分类了约70％的FM患者。此外,超过80%的健康参与者被发现是反应者，而FM患者的发生率约为50％。序贯CPM测试不那么敏感，两组的应答率下降高达40%。另一方面,我们未观察到CPM测量值与临床症状之间存在任何相关性.总之,我们的研究结果证明了所使用的CPM范式的影响，并证实CPM可能是补充FM诊断的有用标志物。然而,研究结果还对CPM作为FM疼痛严重程度标志的敏感性产生怀疑.
