Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits
Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits
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DOI：
10.1093/brain/awt211
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发表时间：
2013-09-01
期刊：
影响因子：
14.5
通讯作者：
Apkarian, A. Vania
中科院分区：
文献类型：
--
作者：
Hashmi, Javeria A.;Baliki, Marwan N.;Apkarian, A. Vania
慢性疼痛状况与大脑结构和功能的异常有关。此外，一些研究表明，与慢性疼痛的主观感知相关的大脑活动可能与急性疼痛的活动不同。然而，后者是基于横截面研究的观察结果。从急性疼痛到慢性疼痛的过渡过程中，大脑活动是如何重组的，这一点尚未被探索。在这里，我们通过检查大脑活动来研究这种转变，以评估背痛幅度的波动。首先，我们比较了背痛相关的脑活动，这些受试者患有类似于2个月的疾病，没有背痛病史1年（早期，急性/亚急性背痛组，n = 94），与背痛生活> 10年的受试者（慢性背痛组，n = 59）。在亚急性背痛患者的一个子集中，我们在1年的时间内纵向跟踪背痛的大脑活动，并比较恢复者（恢复的急性/亚急性背痛组，n = 19）和背痛持续存在者（持续性急性/亚急性背痛组，n = 20;基于1年内背痛强度降低20%）之间的大脑活动。我们报告了与疼痛、情绪和奖励相关的元分析概率图的结果（每张图都基于来自neurosynth.org的200多项脑成像研究）。我们观察到，在早期，急性/亚急性背痛组背痛的大脑活动仅限于急性疼痛涉及的区域，而在慢性背痛组，活动仅限于情绪相关的电路。奖励回路在两组中的代表性相同。在恢复的急性/亚急性背痛组中，大脑活动随着时间的推移而减少，而在持续的急性/亚急性背痛组中，急性疼痛区域的活动减少，情绪相关回路增加，奖励回路保持不变。结果表明，大脑代表一个恒定的感受，背部疼痛，可以经历大规模的转变，在大脑活动的过渡到慢性疼痛。这些观察结果挑战了长期存在的关于大脑和心灵关系的理论概念，并提供了关于慢性疼痛的定义和机制的重要新见解。
Chronic pain conditions are associated with abnormalities in brain structure and function. Moreover, some studies indicate that brain activity related to the subjective perception of chronic pain may be distinct from activity for acute pain. However, the latter are based on observations from cross-sectional studies. How brain activity reorganizes with transition from acute to chronic pain has remained unexplored. Here we study this transition by examining brain activity for rating fluctuations of back pain magnitude. First we compared back pain-related brain activity between subjects who have had the condition for similar to 2 months with no prior history of back pain for 1 year (early, acute/subacute back pain group, n = 94), to subjects who have lived with back pain for > 10 years (chronic back pain group, n = 59). In a subset of subacute back pain patients, we followed brain activity for back pain longitudinally over a 1-year period, and compared brain activity between those who recover (recovered acute/sub-acute back pain group, n = 19) and those in which the back pain persists (persistent acute/sub-acute back pain group, n = 20; based on a 20% decrease in intensity of back pain in 1 year). We report results in relation to meta-analytic probabilistic maps related to the terms pain, emotion, and reward (each map is based on > 200 brain imaging studies, derived from neurosynth.org). We observed that brain activity for back pain in the early, acute/subacute back pain group is limited to regions involved in acute pain, whereas in the chronic back pain group, activity is confined to emotion-related circuitry. Reward circuitry was equally represented in both groups. In the recovered acute/subacute back pain group, brain activity diminished in time, whereas in the persistent acute/subacute back pain group, activity diminished in acute pain regions, increased in emotion-related circuitry, and remained unchanged in reward circuitry. The results demonstrate that brain representation for a constant percept, back pain, can undergo large-scale shifts in brain activity with the transition to chronic pain. These observations challenge long-standing theoretical concepts regarding brain and mind relationships, as well as provide important novel insights regarding definitions and mechanisms of chronic pain.