Decreased Spinothalamic and Dorsal Column Medial Lemniscus-Mediated Function Is Associated with Neuropathic Pain after Spinal Cord Injury
Decreased Spinothalamic and Dorsal Column Medial Lemniscus-Mediated Function Is Associated with Neuropathic Pain after Spinal Cord Injury
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DOI：
10.1089/neu.2012.2343
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发表时间：
2012-11-01
影响因子：
4.2
通讯作者：
Widerstroem-Noga, Eva G.
中科院分区：
文献类型：
--
作者：
Cruz-Almeida, Yenisel;Felix, Elizabeth R.;Widerstroem-Noga, Eva G.
脊髓损伤(SCI)后的神经病理性疼痛(NP)会严重影响患者的生活质量，且对现有的治疗方法往往难以奏效。为了找到更有效的治疗途径，确定每个个体的主要潜在病理生理机制将是有帮助的。本研究的目的是评估脊髓损伤后NP的存在和严重程度与通过背柱内侧丘脑(DCML)通路和脊髓丘脑束(STT)介导的躯体感觉功能的关系。将SCI和NP组(SCI-NP，n=47)和非NP组(SCI-noNP，n=18)在神经损伤(LOI)及其以下区域测量的振动、机械、温度和痛阈值归一化为来自健康无痛对照组(A-B，n=30)的数据。与A-B对照组相比，两个SCI组在LOI处和LOI下的STT介导的功能显著受损(p<；0.001)，但两组之间没有显著差异(NP与非NP)。相反，与SCI-noNP组(z=-1.95+/-0.7，p=0.034)相比，SCI-NP组在LOI处DCML介导的功能损害更明显，表现为更大的振动检测缺陷(z=-3.89+/-0.5)。在SCI-NP组中，NP的严重程度与LOI以下的热敏感性显著相关(r=0.5，p=0.038)。我们的结果提示，STT受损和DCML介导的功能受损在脊髓损伤后NP的发生发展中是必需的。然而，在SCI-NP组中，更严重的NP与LOI以下的热刺激更敏感相关。这一发现与其他研究一致，表明STT损伤和一些节制与NP有关。
Neuropathic pain (NP) after spinal cord injury (SCI) can significantly and negatively affect quality of life and is often refractory to currently available treatments. In order to find more effective therapeutic avenues, it would be helpful to identify the primary underlying pathophysiological mechanisms in each individual. The aim of the present study was to assess the relationship between the presence and severity of NP after SCI and measures of somatosensory function mediated via the dorsal column medial lemniscal (DCML) pathway and the spinothalamic tract (STT). Vibratory, mechanical, thermal, and pain thresholds measured in areas at and below the neurological level of injury (LOI) in persons with SCI and NP (SCI-NP, n = 47) and in persons with SCI without NP (SCI-noNP, n = 18) were normalized to data obtained from able-bodied pain-free control subjects (A-B, n = 30). STT-mediated function at and below the LOI was significantly impaired in both SCI groups compared with A-B controls (p < 0.001), but not significantly different between the two SCI groups (NP vs. no-NP). In contrast, the SCI-NP group had significantly greater impairment of DCML-mediated function at the LOI, as reflected by greater vibratory detection deficits (z = -3.89 +/- 0.5), compared with the SCI-noNP group (z = -1.95 +/- 0.7, p = 0.034). Within the SCI-NP group, NP severity was significantly associated with increased thermal sensitivity below the LOI (r = 0.50, p = 0.038). Our results suggest that both impaired STT and DCML-mediated function are necessary for the development of NP after SCI. However, within the SCI-NP group, greater NP severity was associated with greater sensitivity to thermal stimuli below the LOI. This finding concurs with other studies suggesting that STT damage with some sparing is associated with NP.