【原】纤维肌痛症中注意力镇痛作用的中枢疼痛的调节机制（十二）

 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。

No task × temperature or task × temperature × group interaction (that could be the neural substrate of the observed behavioural interaction between task and temperature, ie, attentional analgesia) was seen at the whole-brain or brainstem level.

在全脑或脑干水平上没有看到任务×温度或任务×温度×组的相互作用（这可能是观察到的任务和温度之间行为相互作用的神经基质，即注意力镇痛）。

A planned analysis sought correlations between the fMRI data (individual BOLD differences between hard|high and easy|high conditions) and the change in pain scores (ie, analgesic effect, easy|high minus hard|high) to improve the power to identify possible neurobiological substrates of the analgesic effect. The whole-brain regression analysis (ie, inter-subject) did not identify any significant regions showing correlation. However, masked brainstem analyses with the same model showed a positive correlation between analgesic effect and the change in activity in both the PAG and the RVM (Fig. 6).

一项计划中的分析寻求fMRI数据（困难|高温和容易|高温条件下的个体BOLD差异）和疼痛评分的变化（即镇痛效果，容易|高温减去困难|高温）之间的相关性，以提高识别镇痛效果可能的神经递质的能力。全脑回归分析（即受试者间）没有发现任何显示相关性的重要区域。然而，用同一模型进行的脑干掩蔽分析显示，镇痛效果与PAG和RVM的活动变化之间存在正相关（图6）。

4. Discussion

In this study, we demonstrate that, contrary to our expectation at the outset, patients with fibromyalgia can produce attentional analgesia with similar efficacy to healthy volunteers. Analysis of the pain ratings during the fMRI experiment revealed that diversion of attentional focus attenuated the pain reported in response to a hot thermal stimulus. This result is in contrast to previous evidence of malfunctioning endogenous pain modulation in patients with fibromyalgia. The specific exemplar of conditioned pain modulation has consistently been found to be impaired in patients with fibromyalgia, up to the point of becoming a test used for the evaluation of novel pharmaceutical therapies. It should be noted, however, that 2 previous reports have provided some evidence that attentional analgesia may be preserved in patients with fibromyalgia. Evoked pain was decreased while performing a Stroop task, although neither study was able to show significant difference in pain scores (ie, analgesia) between the easy (congruent) and hard (incongruent) version of the Stroop task. By controlling for task performance, we can identify that it is the cognitive task difficulty that is modulating pain percept and so demonstrates that this form of attentional pain modulation is intact in patients with fibromyalgia.

4.讨论

在这项研究中，我们证明，与我们一开始的预期相反，纤维肌痛患者可以产生注意力镇痛，其效果与健康对照组相似。对fMRI实验期间疼痛评分的分析显示，注意力焦点的转移减弱了对热刺激产生的疼痛。这一结果与之前纤维肌痛患者的内源性疼痛调节功能失调的观点相反。普遍观点认为在纤维肌痛患者中条件性疼痛调节是受损的，以至于成为评估新型药物疗法的一个测试。然而，应该注意的是，以前的两份报告提供了一些证据，证明纤维肌痛患者的注意力镇痛可能被保留下来。在执行Stroop任务时，诱发的疼痛减少了，尽管这两项研究都未能显示Stroop任务的简单（一致）和困难（不一致）版本之间疼痛评分的显著差异（即镇痛）。通过控制任务表现，我们可以确定是认知任务的难度在调节疼痛感知，因此证明这种形式的注意力疼痛调节在纤维肌痛患者中是完整的。