Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function
Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function
复制标题
DOI：
10.1523/jneurosci.5280-10.2011
复制
发表时间：
2011-05-18
影响因子：
5.3
通讯作者：
Stone, Laura S.
中科院分区：
文献类型：
--
作者：
Seminowicz, David A.;Wideman, Timothy H.;Stone, Laura S.
慢性疼痛与脑灰质减少和认知能力受损有关。在这项纵向研究中，我们评估了神经解剖和功能异常是否可逆，是否依赖于治疗结果。我们获得了慢性腰痛（CLBP）患者在治疗前（n = 18）和治疗后（n = 14） 6个月（脊柱手术或小关节注射）的MRI扫描。此外，我们还扫描了16名健康对照，其中10名在第一次就诊6个月后返回。我们对结构MRI扫描进行了皮质厚度分析，并在功能MRI扫描期间进行了认知任务。我们比较了患者和对照组，以及治疗前和治疗后的患者。治疗后，患者左背外侧前额叶皮层（DLPFC）的皮质厚度增加，与对照组相比，治疗前更薄。DLPFC厚度的增加与疼痛和身体残疾的减轻相关。此外，初级运动皮层的厚度增加与减少身体残疾有关，右前叶岛与减轻疼痛有关。在需要注意的认知任务中，左DLPFC活动在治疗前是异常的，但在治疗后是正常的。这些数据表明，大脑功能和结构异常——特别是左侧dlpfc——是可逆的，这表明治疗慢性疼痛可以恢复人类正常的大脑功能。
Chronic pain is associated with reduced brain gray matter and impaired cognitive ability. In this longitudinal study, we assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes. We acquired MRI scans from chronic low back pain (CLBP) patients before (n = 18) and 6 months after (spine surgery or facet joint injections; n = 14) treatment. In addition, we scanned 16 healthy controls, 10 of which returned 6 months after the first visit. We performed cortical thickness analysis on structural MRI scans, and subjects performed a cognitive task during the functional MRI. We compared patients and controls, as well as patients before versus after treatment. After treatment, patients had increased cortical thickness in the left dorsolateral prefrontal cortex (DLPFC), which was thinner before treatment compared with controls. Increased DLPFC thickness correlated with the reduction of both pain and physical disability. Additionally, increased thickness in primary motor cortex was associated specifically with reduced physical disability, and right anterior insula was associated specifically with reduced pain. Left DLPFC activity during an attention-demanding cognitive task was abnormal before treatment, but normalized following treatment. These data indicate that functional and structural brain abnormalities-specifically in the left DLPFC-are reversible, suggesting that treating chronic pain can restore normal brain function in humans.