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

Blumenstiel, Klaus MD*,†; Gerhardt, Andreas MA*; Rolke, Roman MD‡,§; Bieber, Christiane MD*; Tesarz, Jonas MD*; Friederich, Hans-Christoph MD*; Eich, Wolfgang MD, PhD*; Treede, Rolf-Detlef MD, PhD

doi: 10.1097/AJP.0b013e3182177654
Original Articles

Objectives: Alterations 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.

Methods: We 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 duration: 13.4 y), 23 CBP subjects (mean pain duration: 15.9 y), and 20 healthy controls (HCs). Each participant received the test battery on the back and on the dorsal hand (pain-free control site).

Results: On 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.

Discussion: FMS 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.

*Department of General Internal Medicine and Psychosomatics, Medical Hospital, Ruprecht Karls University Heidelberg, Heidelberg

Department of Psychosomatic Medicine and Psychotherapy, Fürst-Stirum-Hospital, Bruchsal

Department of Neurology, University Medical Center of the Johannes Gutenberg-University, Mainz

§Department of Palliative Care, University of Bonn, Bonn

Division of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Ruprecht Karls University Heidelberg, Mannheim, Germany

Supported by grants of the Federal Ministry of Education and Research (BMBF, grant No. 01EM0112; No. 01EM0506; No. 01EM0901). There are no conflicts of interest related to the manuscript on the part of the authors. Klaus Blumenstiel, MD and Andreas Gerhardt, MA, contributed equally to the study.

Reprints: Andreas Gerhardt, MA, Medical University Hospital Heidelberg, Internal Medicine II, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany (e-mail: andreas.gerhardt@med.uni-heidelberg.de).

Received May 19, 2010

Accepted February 25, 2011

© 2011 Lippincott Williams & Wilkins, Inc.