Chronic Pain is Associated With Reduced Sympathetic Nervous System Reactivity During Simple and Complex Walking Tasks: Potential Cerebral Mechanisms.
Chronic Pain is Associated With Reduced Sympathetic Nervous System Reactivity During Simple and Complex Walking Tasks: Potential Cerebral Mechanisms.
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DOI：
10.1177/24705470211030273
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Cruz-Almeida Y
中科院分区：
文献类型：
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作者：
Yeater TD;Clark DJ;Hoyos L;Valdes-Hernandez PA;Peraza JA;Allen KD;Cruz-Almeida Y
在慢性疼痛状态下，自主神经失调可能导致交感神经反应迟钝。自主反应由中央自主网络（CAN）控制。很少有研究探讨了交感神经的反应性和协会与大脑CAN结构在慢性疼痛的存在下，因此，本研究的目的是探讨慢性疼痛如何影响交感神经的反应性和协会与CAN脑区体积。交感神经反应性测量为静息参考期和典型和复杂步行任务（障碍和双重任务）的步行期之间的皮肤电导水平（ΔSCL）的变化。参与者包括31名患有（n = 19）和没有（n = 12）慢性肌肉骨骼疼痛的人。结构3 T MRI用于确定CAN区域中灰质体积与ΔSCL的关联（即，脑干、杏仁核、杏仁核和前扣带皮层）。ΔSCL在行走任务中各不相同（主效应p = 0.036），在障碍物行走条件下，与试验2和3中的对照组相比，慢性疼痛参与者的ΔSCL较低。典型步行时的ΔSCL与多个CAN灰质体积相关，包括脑干、双侧小脑、杏仁核和右侧尾侧前扣带回皮质（p < 0.05）。从典型步行到障碍步行的ΔSCL的差异与脑干中脑段和小脑环沟前段的体积有关（p < 0.05），而没有其他显著的相关性。典型任务与双重任务步行的ΔSCL差异与双侧尾侧前扣带皮层和左侧喙侧扣带皮层相关（p < 0.05）。慢性疼痛患者在典型和复杂的行走任务中交感神经反应迟钝。此外，钝化的交感神经反应与CAN脑结构相关，其关联方向取决于脑区域。这些结果支持了慢性疼痛可能通过其对大脑的潜在影响而对步行性能所需的典型自主反应产生负面影响的观点。
Autonomic dysregulation may lead to blunted sympathetic reactivity in chronic pain states. Autonomic responses are controlled by the central autonomic network (CAN). Little research has examined sympathetic reactivity and associations with brain CAN structures in the presence of chronic pain; thus, the present study aims to investigate how chronic pain influences sympathetic reactivity and associations with CAN brain region volumes. Sympathetic reactivity was measured as change in skin conductance level (ΔSCL) between a resting reference period and walking periods for typical and complex walking tasks (obstacle and dual-task). Participants included 31 people with (n = 19) and without (n = 12) chronic musculoskeletal pain. Structural 3 T MRI was used to determine gray matter volume associations with ΔSCL in regions of the CAN (i.e., brainstem, amygdala, insula, and anterior cingulate cortex). ΔSCL varied across walking tasks (main effect p = 0.036), with lower ΔSCL in chronic pain participants compared to controls across trials 2 and 3 under the obstacle walking condition. ΔSCL during typical walking was associated with multiple CAN gray matter volumes, including brainstem, bilateral insula, amygdala, and right caudal anterior cingulate cortex (p’s < 0.05). The difference in ΔSCL from typical-to-obstacle walking were associated with volumes of the midbrain segment of the brainstem and anterior segment of the circular sulcus of the insula (p’s < 0.05), with no other significant associations. The difference in ΔSCL from typical-to-dual task walking was associated with the bilateral caudal anterior cingulate cortex, and left rostral cingulate cortex (p’s < 0.05). Sympathetic reactivity is blunted during typical and complex walking tasks in persons with chronic pain. Additionally, blunted sympathetic reactivity is associated with CAN brain structure, with direction of association dependent on brain region. These results support the idea that chronic pain may negatively impact typical autonomic responses needed for walking performance via its potential impact on the brain.