Disrupted brain circuitry for pain-related reward/punishment in fibromyalgia.
Disrupted brain circuitry for pain-related reward/punishment in fibromyalgia.
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纤维肌痛中与疼痛相关的奖励/惩罚的破坏脑电路。
DOI：
10.1002/art.38191
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Napadow V
中科院分区：
文献类型：
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作者：
Loggia ML;Berna C;Kim J;Cahalan CM;Gollub RL;Wasan AD;Harris RE;Edwards RR;Napadow V
虽然纤维肌痛（FM）患者已知表现为痛觉过敏，但导致这种改变的疼痛处理的中心机制尚不完全清楚。在这项研究中，我们调查潜在的神经回路失调的认知和享乐方面的主观经验的疼痛，如预期疼痛和疼痛缓解。对31名FM患者和14名对照组进行FMRI，同时对他们的腿部进行袖带压力疼痛刺激，校准以引起疼痛等级为50/100。在扫描过程中，受试者还收到视觉提示，告知他们即将发生的疼痛（疼痛预期）和疼痛抵消（缓解预期）。在通常被认为涉及感觉、情感、认知和疼痛调节过程的区域内，患者在预期疼痛和预期缓解时表现出较弱的激活。在健康对照中，腹侧被盖区（VTA）的直接搜索和兴趣区分析揭示了一种与惩罚编码相容的活动模式：在疼痛预期和疼痛刺激期间激活，但在缓解预期期间失活。然而，在FM患者中，在疼痛和预期（疼痛和缓解）期间，VTA的活动显著减少或消失。FM患者表现出大脑对奖励/惩罚的反应紊乱。VTA是大脑中奖励相关多巴胺能/ gaba能神经传递的来源，我们的观察结果与FM中多巴胺能/ gaba能神经传递改变的报告相一致。FM中奖励/惩罚信号的减少可能与这些患者疼痛中枢加工的增强和阿片类药物治疗效果的降低有关。
While patients suffering from fibromyalgia (FM) are known to exhibit hyperalgesia, the central mechanisms contributing to this altered pain processing are not fully understood. In this study we investigate potential dysregulation of the neural circuitry underlying cognitive and hedonic aspects of the subjective experience of pain such as anticipation of pain and of pain relief. FMRI was performed on 31 FM patients and 14 controls while they received cuff pressure pain stimuli on their leg, calibrated to elicit a pain rating of ∼50/100. During the scan, subjects also received visual cues informing them of impending pain onset (pain anticipation) and pain offset (relief anticipation). Patients exhibited less robust activations during both anticipation of pain and anticipation of relief within regions commonly thought to be involved in sensory, affective, cognitive and pain-modulatory processes. In healthy controls, direct searches and region-of-interest analyses in the ventral tegmental area (VTA) revealed a pattern of activity compatible with the encoding of punishment: activation during pain anticipation and pain stimulation, but deactivation during relief anticipation. In FM patients, however, VTA activity during pain and anticipation (of both pain and relief) periods was dramatically reduced or abolished. FM patients exhibit disrupted brain responses to reward/punishment. The VTA is a source for reward-linked dopaminergic/GABAergic neurotransmission in the brain and our observations are compatible with reports of altered dopaminergic/GABAergic neurotransmission in FM. Reduced reward/punishment signaling in FM may relate to the augmented central processing of pain and reduced efficacy of opioid treatments in these patients.