Quantitative Sensory Testing Profiles in Chronic Back Pain Are Distinct From Those in Fibromyalgia

• Published in: The Clinical journal of pain Vol. 27; no. 8; pp. 682 - 690
• Main Authors: Blumenstiel, Klaus, Gerhardt, Andreas, Rolke, Roman, Bieber, Christiane, Tesarz, Jonas, Friederich, Hans-Christoph, Eich, Wolfgang, Treede, Rolf-Detlef
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-10-2011; Lippincott Williams & Wilkins
• Subjects: Adult; Analysis of Variance; Back Pain - physiopathology; Biological and medical sciences; Chronic Pain; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Disability Evaluation; Female; Fibromyalgia - diagnosis; Fibromyalgia - physiopathology; Fundamental and applied biological sciences. Psychology; Humans; Hyperalgesia - physiopathology; Male; Medical sciences; Middle Aged; Muscle, Skeletal - innervation; Muscle, Skeletal - physiopathology; Nervous system (semeiology, syndromes); Neurology; Pain Measurement; Pain Threshold - physiology; Physical Stimulation; Sensation - physiology; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Vertebrates: nervous system and sense organs; Vibration; Nociception; chronic back pain (CBP); Nervous system diseases; Lumbar spine; Low back pain; Diseases of the osteoarticular system; quantitative sensory testing (QST); Fibromyalgia; fibromyalgia syndrome (FMS); Spine disease; Striated muscle disease; Chronic; Pain; Dorsalgia; Rachialgia; Dorsal spine
• ISSN: 0749-8047; 1536-5409
• DOI: 10.1097/AJP.0b013e3182177654

OBJECTIVESAlterations in the central nervous system leading to higher pain sensitivity have been shown in both chronic back pain (CBP) and fibromyalgia syndrome (FMS). The aim of this study was to disclose commonalities and differences in the pathophysiology of FMS and CBP.
METHODSWe used the quantitative sensory testing protocol of the German Research Network on Neuropathic Pain to obtain comprehensive profiles of somatosensory functions. The protocol comprised thermal and mechanical detection and pain thresholds, vibration thresholds, and pain sensitivity to sharp and blunt mechanical stimuli. We studied 21 FMS patients (mean pain duration13.4 y), 23 CBP subjects (mean pain duration15.9 y), and 20 healthy controls (HCs). Each participant received the test battery on the back and on the dorsal hand (pain-free control site).
RESULTSOn the back, FMS patients showed increased thermal and mechanical pain sensitivity compared with HCs and CBP participants. On the hand dorsum, FMS patients showed higher mechanical pain sensitivity compared with CBP participants and HCs and higher cold pain sensitivity compared with HCs. CBP participants showed increased pressure pain sensitivity and lower vibration sensitivity on the back, but no significant differences on the hand dorsum compared with HCs.
DISCUSSIONFMS patients showed increased sensitivity for different pain modalities at all measured body areas, suggesting central disinhibition as a potential mechanism. CBP participants in contrast, showed localized alterations within the affected segment possibly due to peripheral sensitization.