Chronic pain and the emotional brain: Specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain
Chronic pain and the emotional brain: Specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain
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DOI：
10.1523/jneurosci.3576-06.2006
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发表时间：
2006-11-22
影响因子：
5.3
通讯作者：
Apkarian, A. Vania
中科院分区：
文献类型：
--
作者：
Baliki, Marwan N.;Chialvo, Dante R.;Apkarian, A. Vania
持续忍受疼痛（慢性疼痛）是一种适应不良的情况，并且被认为与生理和心理的改变有关，然而对于此类状况下涉及的大脑要素却缺乏了解。在此，我们在两组不同的患者（分别为\(n = 13\)和\(n = 11\)）中确定了与慢性背痛（CBP）自发性疼痛相关的大脑区域，并对比了自发性疼痛和热痛（CBP患者和健康受试者，每组\(n = 11\)）之间的大脑活动。在功能性磁共振成像过程中对自发性疼痛波动的连续评分被分为两个部分：高度持续性疼痛和疼痛加剧。慢性背痛的持续性高度疼痛导致内侧前额叶皮质（mPFC；包括喙前扣带回）活动增加。这种mPFC活动与慢性背痛的强度密切相关，并且已知该区域参与负面情绪、反应冲突以及不良结果的检测，尤其是与自我相关的方面。相比之下，慢性背痛的疼痛加剧阶段短暂激活了在急性疼痛中常见的大脑区域，其中岛叶最为典型，它紧密反映了慢性背痛的持续时间。当将慢性背痛的自发性疼痛与热刺激进行对比时，我们观察到mPFC和岛叶之间存在双向分离，前者仅与自发性疼痛的强度相关，后者仅与热刺激的疼痛强度相关。这些发现表明，慢性背痛的主观性自发性疼痛涉及特定的时空神经元机制，与在急性实验性疼痛中观察到的机制不同，这暗示了涉及自我的情感性大脑具有重要作用。
Living with unrelenting pain (chronic pain) is maladaptive and is thought to be associated with physiological and psychological modifications, yet there is a lack of knowledge regarding brain elements involved in such conditions. Here, we identify brain regions involved in spontaneous pain of chronic back pain (CBP) in two separate groups of patients (n = 13 and n = 11), and contrast brain activity between spontaneous pain and thermal pain (CBP and healthy subjects, n = 11 each). Continuous ratings of fluctuations of spontaneous pain during functional magnetic resonance imaging were separated into two components: high sustained pain and increasing pain. Sustained high pain of CBP resulted in increased activity in the medial prefrontal cortex (mPFC; including rostral anterior cingulate). This mPFC activity was strongly related to intensity of CBP, and the region is known to be involved in negative emotions, response conflict, and detection of unfavorable outcomes, especially in relation to the self. In contrast, the increasing phase of CBP transiently activated brain regions commonly observed for acute pain, best exemplified by the insula, which tightly reflected duration of CBP. When spontaneous pain of CBP was contrasted to thermal stimulation, we observe a double-dissociation between mPFC and insula with the former correlating only to intensity of spontaneous pain and the latter correlating only to pain intensity for thermal stimulation. These findings suggest that subjective spontaneous pain of CBP involves specific spatiotemporal neuronal mechanisms, distinct from those observed for acute experimental pain, implicating a salient role for emotional brain concerning the self.