纤维肌痛症中注意力镇痛作用的中枢疼痛的调节机制（二）

 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。

Endogenous pain modulation can also be engaged by cognitive manipulations, such as placebo analgesia or a shift in attentional focus. In healthy subjects, attentional analgesia has been shown to involve brainstem structures such as the rostral ventromedial medulla (RVM), locus coeruleus (LC), and periaqueductal gray (PAG) that mediate a component of their pain modulatory effects through endogenous monoamines. These brainstem regions are intrinsically challenging to image and have been only sparsely investigated in fibromyalgia despite being implicated as part of the causative central pathology.

内源性疼痛调节也可以通过认知操作来进行，如安慰剂镇痛或注意力集中的转移。在健康受试者中，注意力镇痛已被证明涉及脑干结构，如喙状内侧延髓（RVM）、脑室（LC）和颈管周围灰（PAG），它们通过内源性单胺类调节疼痛的作用。这些脑干区域在本质上对成像的研究很薄弱，并且作为纤维肌痛症中枢痛的研究也很少。

The known link between fibromyalgia and impaired cognitive performance in domains such as attention, memory, and executive processing provides a rationale to investigate a form of endogenous analgesia that is driven by cognitive focus, ie, attentional analgesia. We hypothesised that there would be a demonstrable deficiency in attentional analgesia in patients with fibromyalgia and further that whole-brain/brainstem-optimised functional magnetic resonance imaging (fMRI) could determine where any deficit originated within the descending pain modulatory system or the attentional network.

纤维肌痛与注意力、记忆和执行处理等认知能力受损之间存在联系，这为内源性镇痛形式研究提供了理论依据，内源性镇痛形式由认知焦点驱动的，即注意力镇痛。我们假设，纤维肌痛患者的注意力镇痛存在明显的缺陷，并进一步假设，全脑/脑干优化功能磁共振成像(fMRI)可以确定任何下行疼痛调节系统或注意力网络的缺陷所在。

2. Methods

The study had ethical approval from the NHS South Central Oxford B Research Ethics Committee (reference 13/SC/0617). All subjects gave written informed consent for study participation. The study was undertaken in the Clinical Research and Imaging Centre at the University of Bristol(CRiCBristol).

2.方法

该研究获得了 NHS中南牛津 B 研究伦理委员会的伦理批准（参考 13/SC/0617）。全部受试者为参与研究提供了书面知情同意书。该研究是在布里斯托大学临床研究和成像中心进行的。

2.1. Recruitment

Patients with fibromyalgia were recruited from local pain management clinics by clinician referral and poster advertisements. Sex-matched, healthy control subjects were recruited using poster and email advertisements at the University of Bristol. All subjects were screened for participation by telephone before attending for their single session. To meet the inclusion criteria, they required a confirmed clinical diagnosis of fibromyalgia for at least 6 months before entry into the study. Subjects were excluded if they had other chronic painful conditions, were pregnant, or had a history of neurological or major psychiatric illness. In addition, for control subjects, the presence of significant medical disorder precluded participation. Standard safety inclusion/exclusion criteria for participation in MRI studies were also applied. All subjects completed the Widespread Pain and Symptom Severity Index to validate the fibromyalgia diagnosis for patients and to confirm the absence of fibromyalgia symptoms for control subjects.

2.1招募

通过临床医生的介绍和海报广告，从当地的疼痛管理诊所招募了纤维肌痛的患者。通过布里斯托尔大学的海报和电子邮件广告，招募了性别匹配的健康对照组。所有受试者在参加单次治疗前都经过电话筛选，以确定是否参与。为了满足纳入标准，他们需要在纳入研究前至少6个月内被确诊为纤维肌痛。如果受试者有其他慢性疼痛症状、怀孕或有神经或主要精神疾病的病史，则被排除在外。此外，对于对照组受试者来说，如果存在严重疾病也不能参与。参与MRI研究的标准安全纳入/排除标准也被应用。所有受试者都完成了广泛性疼痛和症状严重程度指数，以验证患者的纤维肌痛诊断，并确认对照组没有纤维肌痛的症状。