Pain intensity processing within the human brain: A bilateral, distributed mechanism
Pain intensity processing within the human brain: A bilateral, distributed mechanism
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DOI：
10.1152/jn.1999.82.4.1934
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发表时间：
1999-10-01
影响因子：
2.5
通讯作者：
Iadarola, MJ
中科院分区：
文献类型：
--
作者：
Coghill, RC;Sang, CN;Iadarola, MJ
对人类受试者的功能成像研究已经确定了参与疼痛处理的各种各样的大脑区域。虽然这些大脑区域中的许多区域高度相互关联，并参与多种处理角色，但每个区域通常被孤立地考虑。因此，很少有人注意到全球功能组织的大脑机制介导的疼痛处理。在目前的调查中，我们结合了正电子发射断层扫描与心理物理评估分级疼痛刺激，以更好地表征多区域组织的脊髓上疼痛处理机制，并确定一个大脑机制subserving疼痛强度的处理。多元回归分析显示，感知疼痛强度和激活功能多样的大脑区域，包括那些重要的感觉，运动控制，影响和注意力之间的统计可靠的关系。疼痛强度相关的激活发生在双侧小脑，壳核，丘脑，丘脑，前扣带皮层，和次级躯体感觉皮层，对侧在初级躯体感觉皮层和辅助运动区，同侧在腹侧运动前区。这些结果证实了存在一个高度分布的，双边的棘上机制参与疼痛强度的处理。疼痛强度信息在多个功能不同的脑区中的保存与传统观点形成鲜明对比，传统观点认为疼痛的感觉辨别性处理仅限于躯体感觉皮层，并且可以解释广泛的大脑皮层损伤后对疼痛强度的有意识的保留。
Functional imaging studies of human subjects have identified a diverse assortment of brain areas that are engaged in the processing of pain. Although many of these brain areas are highly interconnected and are engaged in multiple processing roles, each area has been typically considered in isolation. Accordingly, little attention has been given to the global functional organization of brain mechanisms mediating pain processing. In the present investigation, we have combined positron emission tomography with psychophysical assessment of graded painful stimuli to better characterize the multiregional organization of supraspinal pain processing mechanisms and to identify a brain mechanism subserving the processing of pain intensity. Multiple regression analysis revealed statistically reliable relationships between perceived pain intensity and activation of a functionally diverse group of brain regions, including those important in sensation, motor control, affect, and attention. Pain intensity-related activation occurred bilaterally in the cerebellum, putamen, thalamus, insula, anterior cingulate cortex, and secondary somatosensory cortex, contralaterally in the primary somatosensory cortex and supplementary motor area, and ipsilaterally in the ventral premotor area. These results confirm the existence of a highly distributed, bilateral supraspinal mechanism engaged in the processing of pain intensity. The conservation of pain intensity information across multiple, functionally distinct brain areas contrasts sharply with traditional views that sensory-discriminative processing of pain is confined within the somatosensory cortex and can account for the preservation of conscious awareness of pain intensity after extensive cerebral cortical lesions.