Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia
Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia
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DOI：
10.1002/art.10225
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发表时间：
2002-05-01
影响因子：
--
通讯作者：
Clauw, DJ
中科院分区：
文献类型：
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作者：
Gracely, RH;Petzke, F;Clauw, DJ
Objective.使用功能性磁共振成像（fMRI）来评估在施加疼痛压力期间的大脑激活模式，并确定与对照组相比，纤维肌痛（FM）患者的这种模式是否增强。对16例右利手FM患者和16例右利手匹配对照组的左拇指甲床施加压力。每例FM患者在施加中度疼痛压力的同时进行fMRI。将FM患者的功能激活模式与对照组进行比较，对照组在2种条件下进行测试：“刺激压力控制”条件，在此期间，他们接受的压力量与患者所承受的压力量相似;“主观疼痛控制”条件，在此期间，刺激强度增加，以提供与患者所经历的主观疼痛水平相似的疼痛。用足够的压力刺激两组引起相似的疼痛，导致健康对照组19个区域的局部脑血流量增加，患者12个显著区域。两组共有7个区域的fMRI信号增强，1个区域的fMRI信号减弱。相比之下，用引起患者疼痛的相同量的压力刺激对照仅导致2个区域的信号增加，这两个区域都不与患者的激活区域相吻合。接受类似刺激压力的患者组和对照组的统计比较显示，患者组中有13个区域的激活程度更高。相反，在对照组中，类似的刺激压力仅产生1个更大的激活区域。事实上，可比的主观疼痛的条件下，导致激活模式是相似的患者和对照组，而类似的压力导致没有共同的地区的激活和更大的影响，患者，支持的假设，FM的特点是皮质或皮质下增强疼痛处理。
Objective. To use functional magnetic resonance imaging (fMRI) to evaluate the pattern of cerebral activation during the application of painful pressure and determine whether this pattern is augmented in patients with fibromyalgia (FM) compared with controls.Methods. Pressure was applied to the left thumbnail beds of 16 right-handed patients with FM and 16 right-handed matched controls. Each FM patient underwent fMRI while moderately painful pressure was being applied. The functional activation patterns in FM patients were compared with those in controls, who were tested under 2 conditions: the "stimulus pressure control" condition, during which they received an amount of pressure similar to that delivered to patients, and the "subjective pain control" condition, during which the intensity of stimulation was increased to deliver a subjective level of pain similar to that experienced by patients.Results. Stimulation with adequate pressure to cause similar pain in both groups resulted in 19 regions of increased regional cerebral blood flow in healthy controls and 12 significant regions in patients. Increased fMRI signal occurred in 7 regions common to both groups, and decreased signal was observed in 1 common region. In contrast, stimulation of controls with the same amount of pressure that caused pain in patients resulted in only 2 regions of increased signal, neither of which coincided with a region of activation in patients. Statistical comparison of the patient and control groups receiving similar stimulus pressures revealed 13 regions of greater activation in the patient group. In contrast, similar stimulus pressures produced only 1 region of greater activation in the control group.Conclusion. The fact that comparable subjectively painful conditions resulted in activation patterns that were similar in patients and controls, whereas similar pressures resulted in no common regions of activation and greater effects in patients, supports the hypothesis that FM is characterized by cortical or subcortical augmentation of pain processing.