Pain perception: Is there a role for primary somatosensory cortex?
Pain perception: Is there a role for primary somatosensory cortex?
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DOI：
10.1073/pnas.96.14.7705
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发表时间：
1999-07-06
影响因子：
11.1
通讯作者：
Carrier, B
中科院分区：
文献类型：
--
作者：
Bushnell, MC;Duncan, GH;Carrier, B
解剖学、生理学和病变数据表明，复杂的疼痛体验涉及多个皮质区域。这些区域包括初级和次级躯体感觉皮层、前扣带皮层、岛叶皮层和额叶皮层区域。然而，不同的皮层区域在疼痛处理中的作用是有争议的，特别是初级躯体感觉皮层（S1）。人脑成像研究并没有一致地揭示疼痛相关的S1激活，并且对人类皮层损伤和皮层刺激的早期研究也没有揭示S1在疼痛体验中的明确作用。尽管许多实验室的研究表明，S1在出现有害刺激时以及与一些病理性疼痛状态相关时被激活，但其他实验室并未报告此类激活。有几个因素可能导致不同的研究结果。首先，我们有证据表明，S1激活是高度调制的认知因素，改变疼痛的感觉，包括注意力和以前的经验。第二，S1的精确的躯体位置组织可能导致小的局灶性激活，当对受试者的数据进行平均时，脑沟解剖变异性会使其退化。第三，伤害性刺激对S1的兴奋和抑制效应可能是混合的，这在不同的实验范式中可以得到充分的体现。最后，在解释S1中的阴性结果时，统计考虑很重要。我们的结论是，当考虑到这些因素，大量的证据现在强烈支持一个突出的和高度调制的作用，S1皮层在疼痛的感觉方面，包括本地化和歧视的疼痛强度。
Anatomical, physiological, and lesion data implicate multiple cortical regions in the complex experience of pain. These regions include primary and secondary somatosensory cortices, anterior cingulate cortex, insular cortex, and regions of the frontal cortex. Nevertheless, the role of different cortical areas in pain processing is controversial, particularly that of primary somatosensory cortex (S1). Human brain-imaging studies do not consistently reveal pain-related activation of S1, and older studies of cortical lesions and cortical stimulation in humans did not uncover a clear role of S1 in the pain experience. Whereas studies from a number of laboratories show that S1 is activated during the presentation of noxious stimuli as well as in association with some pathological pain states, others do not report such activation. Several factors may contribute to the different results among studies. First, we have evidence demonstrating that S1 activation is highly modulated by cognitive factors that alter pain perception, including attention and previous experience. Second, the precise somatotopic organization of S1 may lead to small focal activations, which are degraded by sulcal anatomical variability when averaging data across subjects. Third, the probable mixed excitatory and inhibitory effects of nociceptive input to S1 could be disparately represented in different experimental paradigms. Finally, statistical considerations are important in interpreting negative findings in S1. We conclude that, when these factors are taken into account, the bulk of the evidence now strongly supports a prominent and highly modulated role for S1 cortex in the sensory aspects of pain, including localization and discrimination of pain intensity.