【原】纤维肌痛症中注意力镇痛作用的中枢疼痛的调节机制（三）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Oliva V, Gregory R, Brooks JCW, Pickering AE. Pain.2022;163(1):125-136. 本次学习由邱凤主治医师主讲。

A total of 54 subjects (32 patients and 22 controls) were screened for the study, of which 14 failed the screening (3 were left-handed, 9 were unable to attend, 1 was unable to lie flat in the scanner, and 1 did not pass the MRI screening). Twenty right-handed patients with fibromyalgia (mean age 43, range 25-60; 18 women) and 20 right-handed, healthy subjects (mean age, 35 years, range 20-59 years; 18 women) participated in the study. The healthy control subjects were 8 years younger on average than the patients with fibromyalgia (t test, P = 0.03). Patients were not required to alter their regular medications which included non-opioid analgesics (n = 13), opioids (n = 9), tricyclic antidepressants/serotonin and noradrenaline reuptake inhibitors (n = 11), and gabapentinoids (n = 7).

本研究共筛选54名受试者(32名患者和22名对照组)，其中14人未能通过筛选（3人是左撇子，9人无法参加，1人无法平躺，1人未通过MRI筛查）。20名右利手纤维肌痛患者（平均年龄43岁，25-60岁；18名女性）和20名右利手健康受试者（平均年龄35岁，20-59岁；18名女性）参加了研究。健康对照组比纤维肌痛患者平均年轻8岁（t检验，p=0.03）。患者不需要改变常规药物，包括非阿片类镇痛剂（n = 13）、阿片类药物（n = 9）、三环类抗抑郁药/羟色胺、去甲肾上腺素再摄取抑制剂（n = 11）以及加巴喷丁类药物（n = 7）。

2.2 Experiment

Written informed consent was taken, and MRI safety questionnaires were completed on the day of study. The subjects were told that the experiment was to examine the interaction between pain and attention in the brain with no mention of the phenomenon of attentional analgesia to avoid generating an expectation about the study purpose. The American College of Rheumatology (ACR) Widespread Pain and Symptom Severity Index was completed with the assistance of clinician experimenters. Assessments were also made using the Edinburgh Handedness Inventory, PainDETECT, the “pain now” and “pain on average” scales from the Brief Pain Inventory, Hospital Anxiety and Depression scale, and Pain Anxiety Symptom Scales. Any medications taken in the 72 hours before the session were recorded for all participants.

2.2 实验

研究人员获得了书面的知情同意书，并在研究当天完成了MRI安全调查问卷。受试者被告知，该实验是为了研究疼痛和注意力在大脑中的相互作用，没有提及注意力镇痛现象，以避免产生对研究目的的期望。临床实验人员的协助完成了美国风湿病学会（ACR）广泛性疼痛和症状严重程度指数。此外，还使用了爱丁堡手势量表、PainDETECT、简易疼痛量表中的 "当前疼痛 "和 "平均疼痛 "量表、医院焦虑和抑郁量表以及疼痛焦虑症状量表进行评估。所有参与者在治疗前72小时内服用的任何药物都被记录下来。

Both groups had a thermal quantitative sensory testing (QST) with a circular contact thermode (CHEPS Pathway, MEDOC, Israel) applied on the left volar forearm using a modified version of the standardised protocol and script (that included warm detection threshold, heat pain threshold, cold detection threshold, and cold pain threshold). Study participants also had pressure pain threshold assessment over the thenar eminence using an algometer (Somedic, Sweden). After a short comfort/snack break, participants moved on to the calibration for the fMRI experiment.

两组受试者均使用圆形接触热电极在左手前臂上进行了热定量感觉测试（QST），使用的是标准化协议和脚本的修改版（包括热觉阈值、热痛觉阈值、冷觉阈值和冷痛阈值）。研究参与者还使用痛觉仪对大鱼际进行了压力痛阈值评估。在短暂的休息后，参与者进行fMRI实验的校准阶段。

The experimental protocol was identical in structure to the one described in our previous studies. In brief, participants received thermal stimuli to their left forearm for 30 seconds at either 36°C (low temperature) or 42 to 45°C (high temperature), and a pseudorandom series of 1-second long “spikes” of 2, 3, or 4°C above these temperatures were superimposed to minimise habituation to stimulation. The high-temperature stimulus was calibrated for each individual to identify the thermal stimulus that produced a 6 of 10 pain score.

实验方案在结构上与我们之前的研究中描述的一致。简而言之，参与者在左前臂上接受36°C（低温）或42-45°C（高温）的热刺激30秒，并在这些温度之上叠加1秒的2、3或4°C的伪随机 "峰值"，以尽量减少对刺激的习惯化。对每个人的高温刺激进行了校准，以确定产生6分疼痛（10分制）的热刺激。