Association of painful human immunodeficiency virus distal sensory polyneuropathy with aberrant expectation of pain relief: functional magnetic resonance imaging evidence.
Association of painful human immunodeficiency virus distal sensory polyneuropathy with aberrant expectation of pain relief: functional magnetic resonance imaging evidence.
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DOI：
10.1093/braincomms/fcab260
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发表时间：
2021
影响因子：
4.8
通讯作者：
Simmons AN
中科院分区：
文献类型：
--
作者：
Strigo IA;Keltner JR;Ellis RJ;Simmons AN
与HIV相关的远端感觉多发性神经病相关的慢性神经病理性疼痛的潜在机制尚不清楚，但40%的远端神经病患者(或所有HIV携带者的20%)患有这种衰弱的疾病。中枢疼痛处理机制被认为有助于HIV神经病理性疼痛的发展，但研究HIV神经病理性疼痛的中枢机制的研究很少。考虑到疼痛的动机性质，我们的目标是检查61例有(N = 30)和无(N = 31)慢性神经病理性疼痛的艾滋病毒相关性远端感觉多发性神经病男性患者对疼痛发生的预期和对疼痛抵消的预期的改变程度。通过对比有和没有神经病理性疼痛的疼痛(脚)和非疼痛(手)部位，我们可以识别在疼痛抵消或缓解的预期期间显示出变化的激活的独特的神经结构。我们的结果显示没有外周机制的证据，即两组之间在温度感觉、主观疼痛反应或表皮神经纤维密度方面缺乏显著差异。同样，我们发现两组之间在疼痛发作预期的主观或大脑机制上没有显著差异。相反，在我们的研究中，我们发现在疼痛预期抵消期间右前岛内存在显著的相互作用，因为与无疼痛组相比，疼痛组的个体在疼痛部位比非疼痛部位表现出更多的前岛激活。我们的发现与对疼痛预期的异常处理相一致，或与疼痛缓解相关的异常机制，可能是由于对慢性内源性疼痛体验的情绪困扰增加所致。与HIV相关的远端感觉多发性神经病相关的慢性神经病理性疼痛的潜在机制尚不清楚。使用功能磁共振，Strigo等人。在那些可能由于慢性内源性疼痛经验缺乏疼痛缓解而发展为神经性疼痛的人中，表现出异常的疼痛预期抵消反应。
Mechanisms underlying chronic neuropathic pain associated with HIV-associated distal sensory polyneuropathy are poorly understood, yet 40% of those with distal neuropathy (or 20% of all people with HIV) suffer from this debilitating condition. Central pain processing mechanisms are thought to contribute to the development of HIV neuropathic pain, yet studies investigating central mechanisms for HIV neuropathic pain are few. Considering the motivational nature of pain, we aimed to examine the degree to which expectation of pain onset and expectation of pain offset are altered in sixty-one male patients with HIV-related distal sensory polyneuropathy with (N = 30) and without (N = 31) chronic neuropathic pain. By contrasting painful (foot) and non-painful (hand) sites between those with and without neuropathic pain, we could identify unique neural structures that showed altered activation during expectation of pain offset or relief. Our results showed no evidence for peripheral mechanisms evidenced by lack of significant between group differences in thermo-sensation, subjective pain response or epidermal nerve fibre density. Likewise, we found no significant differences between groups in subjective or brain mechanisms underlying the expectation of pain onset. Conversely, we found significant interaction within right anterior insula during expectation of pain offset in our study in that individuals in the pain group compared to the no-pain group exhibited increased anterior insula activation on the painful compared to the non-painful site. Our findings are consistent with abnormal processing of expectation of pain offset or abnormal pain relief-related mechanisms potentially due to increased emotional distress regarding the experience of chronic endogenous pain. Mechanisms underlying chronic neuropathic pain associated with HIV-associated distal sensory polyneuropathy are poorly understood. Using functional MRI, Strigo et al. show abnormal expectation of pain offset response in those who developed neuropathic pain potentially due to lack of pain relief regarding the experience of chronic endogenous pain.
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