Functional brain interactions that serve cognitive-affective processing during pain and placebo analgesia
Functional brain interactions that serve cognitive-affective processing during pain and placebo analgesia
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DOI：
10.1016/j.neuroimage.2007.07.057
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发表时间：
2007-12-01
期刊：
影响因子：
5.7
通讯作者：
Robinson, Michael M.
中科院分区：
文献类型：
--
作者：
Craggs, Jason G.;Price, Donald D.;Robinson, Michael M.
疼痛需要感觉、认知和情感信息的整合。安慰剂的使用是许多领域（包括疼痛）中常见的方法学策略。疼痛和安慰剂镇痛（PA）的神经影像学研究尚未确定其作用机制。因为PA必须从高阶过程产生，它可能是由疼痛体验的认知和情感维度的影响。参与这些过程的大脑区域网络包括前扣带回和后扣带回（A-Ins，P-Ins）、背侧前扣带回皮质（DACC）、背外侧前额叶皮质（DLPFC）和辅助运动区（SMA）。我们使用连接性分析来研究一组慢性疼痛患者中安慰剂镇痛相关的潜在机制。fMRI数据的结构方程模型（SEM）评估了这些区域在三种条件下的区域间连接：（1）初始基线（B1），（2）安慰剂（PA）和（3）安慰剂匹配（PM）。左半球B1数据的SEM结果证实了假设的区域关系。然而，区域间关系是动态的，网络模式因半球和条件而异。在PA和PM条件下与B1模型的偏差对应于我们对疼痛预期的操纵。跨条件的区域间影响的动态变化的背景下，参与诱导和维护PA的自我加强的反馈回路进行解释。虽然安慰剂镇痛可能部分来自伤害性信号的传入抑制，但其机制可能涉及认知情感网络与来自两个半球的输入的相互作用。(C)2007年爱思唯尔公司All rights reserved.
Pain requires the integration of sensory, cognitive, and affective information. The use of placebo is a common methodological ploy in many fields, including pain. Neuroimaging studies of pain and placebo analgesia (PA) have yet to identify a mechanism of action. Because PA must result from higher order processes, it is likely influenced by cognitive and affective dimensions of the pain experience. A network of brain regions involved in these processes includes the anterior and posterior insula (A-Ins, P-Ins), dorsal anterior cingulate cortex (DACC), dorsolateral prefrontal cortex (DLPFC), and the supplementary motor area (SMA). We used connectivity analyses to investigate the underlying mechanisms associated with Placebo analgesia in a group of chronic pain patients. Structural equation models (SEM) of fMRI data evaluated the inter-regional connectivity of these regions across three conditions: (1) initial Baseline (B1), (2) placebo (PA), and (3) Placebo Match (PM). SEM results of B1 data in the left hemisphere confirmed hypothesized regional relationships. However, inter-regional relationships were dynamic and the network models varied across hemispheres and conditions. Deviations from the B1 model in the PA and PM conditions correspond to our manipulation of expectation for pain. The dynamic changes in inter-regional influence across conditions are interpreted in the context of a self-reinforcing feedback loop involved in the induction and maintenance of PA. Although it is likely that placebo analgesia results partly from afferent inhibition of a nociceptive signal, the mechanisms likely involve the interaction of a cognitive-affective network with input from both hemispheres. (C) 2007 Elsevier Inc. All rights reserved.