Striatal hypofunction as a neural correlate of mood alterations in chronic pain patients
Striatal hypofunction as a neural correlate of mood alterations in chronic pain patients
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DOI：
10.1016/j.neuroimage.2020.116656
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发表时间：
2020-05-01
期刊：
影响因子：
5.7
通讯作者：
Loggia, Marco L.
中科院分区：
文献类型：
--
作者：
Kim, Minhae;Mawla, Ishtiaq;Loggia, Marco L.
背景：慢性疼痛和情绪障碍具有共同的神经解剖学基础，涉及奖赏系统的破坏。虽然负性情感(NA)的增加和积极情感(PA)的减少是慢性疼痛患者临床表现复杂化的众所周知的因素，但我们对疼痛和PA/NA之间相互作用的机制的了解仍然有限。在这里，我们使用了一项有效的任务，结合功能磁共振成像(FMRI)来探测行为和神经对金钱奖赏和损失的反应，以得出纹状体功能障碍的假设，纹状体是参与编码动机突显的关键中脑边缘结构，与慢性疼痛并存的情绪变化有关。方法：28名慢性肌肉骨骼疼痛患者(慢性下腰痛，n=15；纤维肌痛，n=13)和18名健康对照在执行货币诱因延迟(MID)任务时进行了fMRI检查。比较不同组的行为和神经反应，并与抑郁(Beck抑郁问卷)和享乐能力(Snaith-Hamilton愉悦量表)相关联。结果：与对照组相比，患者在中期任务的奖赏和损失试验(PS<；0.05)中表现出更高的快感缺乏和抑郁评分，纹状体激活和与激励相关的行为促进(反应时减少)。在所有参与者中，在奖励试验中，右侧纹状体的激活程度较低，与激励相关的行为便利化程度较低，快感缺失得分较高(PS<；0.05)。最后，在患者中，较低的双侧纹状体激活与较高的抑郁评分相关(PS<；0.05)。结论：在慢性疼痛中，PA减少和NA增加伴随着中间任务所测量的纹状体功能减退。
Background: Chronic pain and mood disorders share common neuroanatomical substrates involving disruption of the reward system. Although increase in negative affect (NA) and decrease in positive affect (PA) are well-known factors complicating the clinical presentation of chronic pain patients, our understanding of the mechanisms underlying the interaction between pain and PA/NA remains limited. Here, we used a validated task probing behavioral and neural responses to monetary rewards and losses in conjunction with functional magnetic resonance imaging (fMRI) to WA the hypothesis that dysfunction of the striatum, a key mesolimbic structure involved in the encoding of motivational salience, relates to mood alterations comorbid with chronic pain.Methods: Twenty-eight chronic musculoskeletal pain patients (chronic low back pain, n=15; fibromyalgia, n=13) and 18 healthy controls underwent fMRI while performing the Monetary Incentive Delay (MID) task. Behavioral and neural responses were compared across groups and correlated against measures of depression (Beck Depression Inventory) and hedonic capacity (Snaith-Hamilton Pleasure Scale).Results: Compared to controls, patients demonstrated higher anhedonia and depression scores, and a dampening of striatal activation and incentive-related behavioral facilitation (reduction in reaction times) during reward and loss trials of the MID task (ps < 0.05). In all participants, lower activation of the right striatum during reward trials was correlated with lower incentive-related behavioral facilitation and higher anhedonia scores (ps < 0.05). Finally, among patients, lower bilateral striatal activation during loss trials was correlated with higher depression scores (ps < 0.05).Conclusions: In chronic pain, PA reduction and NA increase are accompanied by striatal hypofunction as measured by the MID task.