Brain signature and functional impact of centralized pain: a multidisciplinary approach to the study of chronic pelvic pain (MAPP) network study
Brain signature and functional impact of centralized pain: a multidisciplinary approach to the study of chronic pelvic pain (MAPP) network study
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DOI：
10.1097/j.pain.0000000000001001
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发表时间：
2017-10-01
期刊：
影响因子：
7.4
通讯作者：
Harris, Richard E.
中科院分区：
文献类型：
--
作者：
Kutch, Jason J.;Ichesco, Eric;Harris, Richard E.
慢性疼痛通常通过严重程度评分来衡量，而忽略了其在全身的空间分布。这种广泛的疼痛被认为是集中化的标志，集中化是一种将疼痛感知与伤害性输入分离的中枢神经系统过程。在这里，我们利用慢性盆腔疼痛研究网络 (MAPP) 多学科方法研究中 1079 名参与者的数据，调查了集中化是否表现在大脑层面。将临床诊断为泌尿科慢性盆腔疼痛综合征（UCPPS）的参与者与无痛对照组和纤维肌痛（典型的集中性疼痛障碍）患者进行比较。参与者完成了问卷调查，记录疼痛的严重程度、功能和疼痛的身体图。一个子集（UCPPS N = 110；纤维肌痛 N = 23；健康对照 N = 49）接受了功能和结构磁共振成像。 UCPPS 患者报告疼痛范围从局部（骨盆）到广泛（全身）。患有广泛性 UCPPS 的患者表现出大脑灰质体积和涉及感觉运动和岛叶皮质的功能连接增加（P < 0.05 校正）。这些变化在疾病诊断中得到体现，因为纤维肌痛患者出现相同的结果，但无痛对照组则不然。广泛的疼痛还与身体和精神功能下降有关，与疼痛的严重程度无关。集中性疼痛患者的脑病理学与全身的疼痛分布有关。这些患者可能会受益于针对中枢神经系统的干预措施。
Chronic pain is often measured with a severity score that overlooks its spatial distribution across the body. This widespread pain is believed to be a marker of centralization, a central nervous system process that decouples pain perception from nociceptive input. Here, we investigated whether centralization is manifested at the level of the brain using data from 1079 participants in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network (MAPP) study. Participants with a clinical diagnosis of urological chronic pelvic pain syndrome (UCPPS) were compared to pain-free controls and patients with fibromyalgia, the prototypical centralized pain disorder. Participants completed questionnaires capturing pain severity, function, and a body map of pain. A subset (UCPPS N = 110; fibromyalgia N = 23; healthy control N = 49) underwent functional and structural magnetic resonance imaging. Patients with UCPPS reported pain ranging from localized (pelvic) to widespread (throughout the body). Patients with widespread UCPPS displayed increased brain gray matter volume and functional connectivity involving sensorimotor and insular cortices (P < 0.05 corrected). These changes translated across disease diagnoses as identical outcomes were present in patients with fibromyalgia but not pain-free controls. Widespread pain was also associated with reduced physical and mental function independent of pain severity. Brain pathology in patients with centralized pain is related to pain distribution throughout the body. These patients may benefit from interventions targeting the central nervous system.