An fMRI-based neurologic signature of physical pain.
An fMRI-based neurologic signature of physical pain.
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DOI：
10.1056/nejmoa1204471
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发表时间：
2013-04-11
期刊：
影响因子：
--
通讯作者：
Kross E
中科院分区：
文献类型：
--
作者：
Wager TD;Atlas LY;Lindquist MA;Roy M;Woo CW;Kross E
持续性疼痛是通过自我报告的方式来测量的，唯一的依赖阻碍了诊断和治疗。功能性磁共振成像（fMRI）有希望确定疼痛的客观措施，但大脑的措施，是敏感和具体的身体疼痛尚未确定。在涉及114名参与者的四项研究中，我们开发了一种基于fMRI的测量方法，可以预测个人水平的疼痛强度。在研究1中，我们使用机器学习分析来识别大脑区域的fMRI活动模式-一种神经学特征-与热诱导疼痛相关。该模式包括丘脑、后岛叶和前岛叶、次级躯体感觉皮层、前扣带皮层、导水管周围灰质和其他区域。在研究2中，我们在一个新的样本中测试了疼痛与温暖的敏感性和特异性。在研究3中，我们评估了与社会疼痛相关的特异性，社会疼痛激活了许多与身体疼痛相同的大脑区域。在研究4中，我们评估了对镇痛剂瑞芬太尼的反应性。在研究1中，神经学特征显示在区分疼痛性发热与非疼痛性发热、疼痛预期和疼痛回忆方面的敏感性和特异性为94%或更高（95%置信区间[CI]，89 - 98）。在研究2中，该特征区分疼痛性发热和非疼痛性发热的敏感性和特异性为93%（95%CI，84至100）。在研究3中，它区分身体疼痛和社会疼痛的敏感性为85%（95%CI，76至94）和特异性为73%（95%CI，61至84），在两种情况中哪一种更痛苦的强制选择测试中的敏感性和特异性为95%。在研究4中，当给予瑞芬太尼时，签名反应的强度显著降低。这是可能的，使用功能磁共振成像评估疼痛引起的有害热在健康人。未来的研究需要评估是否签名预测临床疼痛。（由国家药物滥用研究所和其他机构资助。
Persistent pain is measured by means of self-report, the sole reliance on which hampers diagnosis and treatment. Functional magnetic resonance imaging (fMRI) holds promise for identifying objective measures of pain, but brain measures that are sensitive and specific to physical pain have not yet been identified. In four studies involving a total of 114 participants, we developed an fMRI-based measure that predicts pain intensity at the level of the individual person. In study 1, we used machine-learning analyses to identify a pattern of fMRI activity across brain regions — a neurologic signature — that was associated with heat-induced pain. The pattern included the thalamus, the posterior and anterior insulae, the secondary somatosensory cortex, the anterior cingulate cortex, the periaqueductal gray matter, and other regions. In study 2, we tested the sensitivity and specificity of the signature to pain versus warmth in a new sample. In study 3, we assessed specificity relative to social pain, which activates many of the same brain regions as physical pain. In study 4, we assessed the responsiveness of the measure to the analgesic agent remifentanil. In study 1, the neurologic signature showed sensitivity and specificity of 94% or more (95% confidence interval [CI], 89 to 98) in discriminating painful heat from nonpainful warmth, pain anticipation, and pain recall. In study 2, the signature discriminated between painful heat and nonpainful warmth with 93% sensitivity and specificity (95% CI, 84 to 100). In study 3, it discriminated between physical pain and social pain with 85% sensitivity (95% CI, 76 to 94) and 73% specificity (95% CI, 61 to 84) and with 95% sensitivity and specificity in a forced-choice test of which of two conditions was more painful. In study 4, the strength of the signature response was substantially reduced when remifentanil was administered. It is possible to use fMRI to assess pain elicited by noxious heat in healthy persons. Future studies are needed to assess whether the signature predicts clinical pain. (Funded by the National Institute on Drug Abuse and others.)