Altered functional connectivity between the insula and the cingulate cortex in patients with temporomandibular disorder: a pilot study.
Altered functional connectivity between the insula and the cingulate cortex in patients with temporomandibular disorder: a pilot study.
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DOI：
10.1111/j.1526-4610.2011.01998.x
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发表时间：
2012-03
期刊：
影响因子：
5
通讯作者：
Schmidt-Wilcke T
中科院分区：
文献类型：
--
作者：
Ichesco E;Quintero A;Clauw DJ;Peltier S;Sundgren PM;Gerstner GE;Schmidt-Wilcke T
其中最常见的慢性疼痛状况，但知之甚少，是颞下颌关节紊乱病（TMD），与西方人群的患病率估计为3 - 15%。虽然人们越来越多地认识到，中枢神经系统机制有助于疼痛放大和慢性TMDs，需要进一步的研究来解开神经相关，可能会助长慢性疼痛的发展。岛叶皮层（IC）和扣带皮层（CC）都与疼痛体验密切相关。目前的研究旨在专门调查在TMD患者和健康对照（HC），无论是在休息状态和疼痛刺激的应用程序中的IC-CC功能连接。8例TMD患者和8例年龄、性别匹配的健康对照者参加了本研究。在休息状态下，并在执行过程中的压力疼痛刺激太阳穴的功能磁共振成像数据被收购。将预定义的种子区域放置在IC（前部和后部岛叶皮质）中，并且将提取的信号与整个大脑的大脑活动相关联。具体而言，我们感兴趣的是TMD患者和HC是否会在静息状态和对面部施加疼痛刺激期间显示IC-CC连接的差异。作为一个主要的发现功能连接分析显示，在休息状态和施加的压力疼痛的TMD患者的左前IC和膝前ACC之间的功能连接增加。在患者组中，通过VAS测量，前IC-ACC连接与临床疼痛强度之间存在负相关性。由于ACC的指前区在抗伤害感受中起着关键作用，我们假设前部IC - ACC连接的增加表明疼痛调节系统在慢性过程的早期发生了适应。
Amongst the most common chronic pain conditions, yet poorly understood, are temporomandibular disorders (TMDs), with a prevalence estimate of 3 – 15% for Western populations. Although it is increasingly acknowledged that central nervous system mechanisms contribute to pain amplification and chronicity in TMDs, further research is needed to unravel neural correlates that might abet the development of chronic pain. The insular cortex (IC) and cingulate cortex (CC) are both critically involved in the experience of pain. The current study sought specifically to investigate IC-CC functional connectivity in TMD patients and healthy controls (HCs), both during resting state and during the application of a painful stimulus. Eight patients with TMD, and 8 age and sex matched healthy controls (HCs) were enrolled in the present study. FMRI data during resting state and during the performance of a pressure pain stimulus to the temple were acquired. Predefined seed regions were placed in the IC (anterior and posterior insular cortices) and the extracted signal was correlated with brain activity throughout the whole brain. Specifically we were interested whether TMD patients and HCs would show differences in IC – CC connectivity, both during resting state and during the application of a painful stimulus to the face. As a main finding functional connectivity analyses revealed an increased functional connectivity between the left anterior IC and pregenual ACC in TMD patients, during both resting state and applied pressure pain. Within the patient group there was a negative correlation between the anterior IC - ACC connectivity and clinical pain intensity as measured by a VAS. Since the pregenual region of the ACC is critically involved in antinociception, we hypothesize that an increase in anterior IC – ACC connectivity is indicative of an adaptation of the pain modulatory system early in the chronification process.
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