Deficits in ascending and descending pain modulation pathways in patients with postherpetic neuralgia
Deficits in ascending and descending pain modulation pathways in patients with postherpetic neuralgia
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带状疱疹后神经痛患者的上行和下行疼痛调节途径缺陷
DOI：
10.1016/j.neuroimage.2020.117186
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发表时间：
2020-11-01
期刊：
影响因子：
5.7
通讯作者：
Hu, Li
中科院分区：
文献类型：
--
作者：
Li, Hong;Li, Xiaoyun;Hu, Li
带状疱疹后神经痛（PHN），发展后的决议带状疱疹粘膜皮肤疹，是一种衰弱的慢性疼痛。然而，目前对PHN患者上行和下行疼痛调节相关的潜在机制缺乏了解。在这里，我们结合心理物理学与结构和功能磁共振成像（MRI）技术，调查PHN患者的大脑变化。心理物理测试表明，与健康对照组相比，PHN患者有增加的状态和特质焦虑和抑郁。结构性MRI数据表明，PHN患者的丘脑和杏仁核灰质体积明显小于健康对照组，并且丘脑体积与PHN患者的疼痛强度呈负相关（使用麦吉尔疼痛问卷的简短形式评估）。当丘脑和中脑导水管周围灰质（PAG）被用作种子时，静息态功能MRI数据显示PHN患者上行和下行疼痛通路内的功能连接模式异常，例如，丘脑和躯体感觉皮质之间的功能连接增加，PAG和额叶皮质之间的功能连接减少。此外，主观评分的现在疼痛指数（PPI）和贝克抑郁量表（BDI）与PAG和初级躯体感觉皮层（SI）之间的功能连接的强度呈负相关，重要的是，BDI对PPI的影响是由PAG-SI功能连接介导的。总的来说，我们的研究结果提供了证据表明上行和下行疼痛调制通路的缺陷，这与PHN患者的慢性疼痛强度及其情感共病高度相关。因此，我们的研究加深了我们对PHN发病机制的认识，这将有助于确定患者的最佳治疗方案。
Postherpetic Neuralgia (PHN), develops after the resolution of the herpes zoster mucocutaneous eruption, is a debilitating chronic pain. However, there is a lack of knowledge regarding the underlying mechanisms associated with ascending and descending pain modulations in PHN patients. Here, we combined psychophysics with structural and functional magnetic resonance imaging (MRI) techniques to investigate the brain alternations in PHN patients. Psychophysical tests showed that compared with healthy controls, PHN patients had increased state and trait anxiety and depression. Structural MRI data indicated that PHN patients had significantly smaller gray matter volumes of the thalamus and amygdala than healthy controls, and the thalamus volume was negatively correlated with pain intensity (assessed using the Short-form of the McGill pain questionnaire) in PHN patients. When the thalamus and periaqueductal gray matter (PAG) were used as the seeds, resting-state functional MRI data revealed abnormal patterns of functional connectivity within ascending and descending pain pathways in PHN patients, e.g., increased functional connectivity between the thalamus and somatosensory cortices and decreased functional connectivity between the PAG and frontal cortices. In addition, subjective ratings of both Present Pain Index (PPI) and Beck-Depression Inventory (BDI) were negatively correlated with the strength of functional connectivity between the PAG and primary somatosensory cortex (SI), and importantly, the effect of BDI on PPI was mediated by the PAG-SI functional connectivity. Overall, our results provided evidence suggesting deficits in ascending and descending pain modulation pathways, which were highly associated with the intensity of chronic pain and its emotional comorbidities in PHN patients. Therefore, our study deepened our understanding of the pathogenesis of PHN, which would be helpful in determining the optimized treatment for the patients.