Forebrain mechanisms of nociception and pain: Analysis through imaging
Forebrain mechanisms of nociception and pain: Analysis through imaging
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DOI：
10.1073/pnas.96.14.7668
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发表时间：
1999-07-06
影响因子：
11.1
通讯作者：
Casey, KL
中科院分区：
文献类型：
--
作者：
Casey, KL
疼痛是由相互作用的辨别、情感动机和认知成分组成的统一体验，其中每一个成分都通过作用于脊髓、脑干和大脑水平的前脑机制来介导和调节。人类前脑相对于脊髓的大小在解剖学上强调前脑对伤害性处理的控制。人类前脑病理学可以在不激活伤害感受器的情况下引起疼痛。正电子发射断层扫描（PET）正常人脑的功能成像显示，在几个区域，特别是在疼痛期间，突触诱导的局部脑血流量（rCBF）增加。我们已经研究了性别，伤害性刺激的类型，和伤害性输入的起源作为潜在的决定因素的模式和强度的rCBF反应的变量。在不同性别和接触性热痛、冷痛、皮肤激光痛或肌内痛期间，激活最一致的结构是对侧丘脑和前扣带皮层、双侧丘脑和运动前皮层以及小脑蚓部，这些区域通常在其他研究者进行的疼痛PET研究中被激活，并且脑rCBF反应的强度与感知的疼痛强度参数相关。为了补充人体研究，我们开发了一种动物模型，用于研究刺激诱导的大鼠rCBF反应。与行为测量和人PET的结果雅阁，在皮下注射福尔马林之后，在脑和脑干中存在躯体感觉和边缘系统结构的进行性和选择性激活。动物模型和人体PET研究应该是相辅相成的，从而促进理解正常和病理性疼痛的前脑机制的进展。
Pain is:a unified experience composed of interacting discriminative, affective-motivational, and cognitive components, each of which is mediated and modulated through forebrain mechanisms acting at spinal, brainstem, and cerebral levels. The size of the human forebrain in relation to the spinal cord gives anatomical emphasis to forebrain control over nociceptive processing. Human forebrain pathology can cause pain without the activation of nociceptors. Functional imaging of the normal human brain with positron emission tomography (PET) shows synaptically induced increases in regional cerebral blood flow (rCBF) in several regions specifically during pain. We have examined the variables of gender, type of noxious stimulus, and the origin of nociceptive input as potential determinants of the pattern and intensity of rCBF responses. The structures most consistently activated across genders and during contact heat pain, cold pain, cutaneous laser pain or intramuscular pain were the contralateral insula and anterior cingulate cortex, the bilateral thalamus and premotor cortex, and the cerebellar vermis, These regions are commonly activated in PET studies of pain conducted by other investigators, and the intensity of the brain rCBF response correlates parametrically with perceived pain intensity. To complement the human studies, we developed an animal model for investigating stimulus-induced rCBF responses in the rat. In accord with behavioral measures and the results of human PET, there is a progressive and selective activation of somatosensory and limbic system structures in the brain and brainstem following the subcutaneous injection of formalin. The animal model and human PET studies should be mutually reinforcing and thus facilitate progress in understanding forebrain mechanisms of normal and pathological pain.