Predicting transition to chronic pain.
Predicting transition to chronic pain.
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DOI：
10.1097/wco.0b013e32836336ad
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发表时间：
2013-08
影响因子：
4.8
通讯作者：
Farmer MA
中科院分区：
文献类型：
--
作者：
Apkarian AV;Baliki MN;Farmer MA
大多数在煽动事件后出现疼痛的人会在伤口愈合时恢复到健康状态。然而，一小部分人继续遭受痛苦，即过渡到慢性疼痛。慢性疼痛可能会持续数年，并伴有认知异常，以及生活质量下降。在动物身上，持续性疼痛的特征是外周和脊髓的重组，而最近在人类身上的证据也表明皮质重组。然而，尽管进行了30多年的研究，但对于调节从急性疼痛向慢性疼痛过渡的神经机制，几乎没有达成一致意见。在一项纵向的脑成像研究中，对背部剧烈疼痛发作的个体进行了为期一年的跟踪调查，在此期间反复收集疼痛和大脑参数。少数健康个体和慢性背痛患者也同时被研究，作为阳性和阴性对照。在进入研究时，内侧前额叶皮质和伏隔核之间的同步性强度(即功能连接)可以预测1年后转变为慢性化的个体(准确率为80%)。大脑情绪学习回路的特性预测了过渡到慢性疼痛的可能性。这一回路与疼痛的关系仍未得到很大的了解。未来的人类和动物模型研究是必要的，以揭示驱动疼痛慢性化的潜在机制，并有可能发展预防疼痛慢性化的新疗法。
Most individuals who develop pain following an inciting event will return to a healthy state as the injury heals. However, a small percentage continue to suffer, that is, transition to chronic pain. Chronic pain may persist for years and is accompanied by cognitive abnormalities, as well as diminished quality of life. In animals, persistent pain is characterized by peripheral and spinal cord reorganization, and recent evidence in humans also indicates cortical reorganization. Yet, despite more than 30 years of research, there is little agreement on the neural mechanisms that mediate the transition from acute to chronic pain. In a longitudinal brain-imaging study, individuals who developed an intense back pain episode were followed over a 1-year period, during which pain and brain parameters were collected repeatedly. A smaller number of healthy individuals and chronic back pain patients were also studied concomitantly, as positive and negative controls. At the time of entry into the study, strength of synchrony between the medial prefrontal cortex and nucleus accumbens (i.e. functional connectivity) was predictive (>80% accuracy) of individuals who subsequently transition to chronicity 1 year later. Properties of the brain’s emotional learning circuitry predict the transition to chronic pain. The involvement of this circuitry in pain remains mostly unexplored. Future human and animal model studies are necessary to unravel underlying mechanisms driving pain chronicity, with the potential of advancing novel therapeutics for preventing pain chronification.