Affective disturbances modulate the neural processing of visceral pain stimuli in irritable bowel syndrome: an fMRI study
Affective disturbances modulate the neural processing of visceral pain stimuli in irritable bowel syndrome: an fMRI study
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DOI：
10.1136/gut.2008.175000
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发表时间：
2010-04-01
期刊：
影响因子：
24.5
通讯作者：
Gizewski, E. R.
中科院分区：
文献类型：
--
作者：
Elsenbruch, S.;Rosenberger, C.;Gizewski, E. R.
目的探讨焦虑和抑郁症状在肠易激综合征（IBS）患者疼痛过程改变中的作用。设计在这项功能性磁共振成像研究中，评估了在先前确定的个体不适阈值下直肠扩张时血氧水平依赖（BOLD）反应。患者15例女性肠易激综合征（IBS）患者，直肠疼痛阈值正常，和12名健康女性。测量在IBS内分析了用医院焦虑和抑郁量表（HADS）测量的焦虑和抑郁症状与主观疼痛评分和扩张诱导的脑激活期间的BOLD反应的相关性。疼痛引起的大脑激活与不控制HADS scores.Results组的差异进行了评估，IBS患者经历了显着更多的疼痛和不适后，直肠扩张的扫描仪，尽管直肠感觉阈值不变。焦虑和抑郁评分与这些主观刺激评分相关，但与直肠感觉阈值无关。IBS的焦虑症状与疼痛引起的前中扣带回皮质和前扣带回皮质的激活显着相关。抑郁评分与IBS中前额叶皮层（PFC）和小脑区域的激活相关。两样本t检验的组间比较显示，IBS与对照组相比，前岛叶皮层和PFC显著激活。将焦虑和抑郁评分分别作为混杂变量，导致组间差异显著性丧失。结论IBS内脏刺激的中枢处理改变至少部分由焦虑和抑郁症状介导，其可以调节疼痛反应的情感动机方面。
Objective To address the role of anxiety and depression symptoms in altered pain processing in irritable bowel syndrome (IBS).Design In this functional magnetic resonance imaging study, the blood oxygen level-dependent (BOLD) response to rectal distensions delivered at previously determined individual discomfort thresholds was assessed.Patients 15 female patients with irritable bowel syndrome (IBS) and with normal rectal pain thresholds, and 12 healthy women.Measures The correlation of anxiety and depression symptoms, measured with the Hospital Anxiety and Depression Scale (HADS), with subjective pain ratings and the BOLD response during distension-induced brain activation were analysed within IBS. Group differences in pain-induced brain activation with and without controlling for HADS scores were evaluated.Results Patients with IBS experienced significantly more pain and discomfort upon rectal distensions in the scanner, despite unaltered rectal sensory thresholds. Anxiety and depression scores were associated with these subjective stimulus ratings, but not with rectal sensory thresholds. Anxiety symptoms in IBS were significantly associated with pain-induced activation of the anterior midcingulate cortex and pregenual anterior cingulate cortex. Depression scores correlated with activation of the prefrontal cortex (PFC) and cerebellar areas within IBS. Group comparisons with the two-sample t test revealed significant activation in the IBS versus controls contrast in the anterior insular cortex and PFC. Inclusion of anxiety and depression scores, respectively, as confounding variables led to a loss of significant group differences.Conclusions Altered central processing of visceral stimuli in IBS is at least in part mediated by symptoms of anxiety and depression, which may modulate the affective-motivational aspects of the pain response.