Changes in functional connectivity of pain modulatory systems in women with primary dysmenorrhea
Changes in functional connectivity of pain modulatory systems in women with primary dysmenorrhea
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DOI：
10.1097/j.pain.0000000000000340
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发表时间：
2016-01
期刊：
影响因子：
7.4
通讯作者：
Shyh-Yuh Wei;H. Chao;C. Tu;Wei-Chi Li;Intan Low;Chih-Ying Chuang;Li-Fen Chen;J. Hsieh
中科院分区：
文献类型：
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作者：
Shyh-Yuh Wei;H. Chao;C. Tu;Wei-Chi Li;Intan Low;Chih-Ying Chuang;Li-Fen Chen;J. Hsieh
摘要月经痛是最常见的妇科疾病，通常无器质性原因（称为原发性痛经，PDM）。PDM在晚年与许多功能性疼痛疾病（与疼痛抑制的中枢功能障碍相关，如纤维肌痛）的高共病率表明，年轻PDM女性中可能已经发生了疼痛调节系统的适应不良功能，使其易受功能性疼痛疾病的影响。中脑导水管周围灰质（PAG）的功能作为一个重要的枢纽，在神经轴的疼痛调节系统，因此，我们调查的功能连接的PAG在PDM。46名PDM受试者和49名对照者在月经期和排卵期接受静息态功能磁共振成像。PDM受试者的PAG在疼痛月经期间表现出与感觉运动皮层的适应性/反应性超连接，而在月经或排卵期，它表现出与背外侧前额叶皮层和默认模式网络（涉及腹内侧前额叶皮层，后扣带皮层或后顶叶皮层）的适应性低连接。我们认为，PDM中的适应不良的下行疼痛调节系统可能是在以后生活中对各种功能障碍的后续发展的中枢易感性的基础。越来越多的证据表明PAG和默认模式网络之间的低连通性是许多功能性疼痛障碍的共同终点，这一假设得到了证实。
Abstract Menstrual pain is the most prevalent gynecological complaint, and is usually without organic cause (termed primary dysmenorrhea, PDM). The high comorbidity in the later life of PDM with many functional pain disorders (associated with central dysfunction of pain inhibition, eg, fibromyalgia) suggests possible maladaptive functionality of pain modulatory systems already occurred in young PDM women, making them vulnerable to functional pain disorders. Periaqueductal gray (PAG) matter functions as a critical hub in the neuraxis of pain modulatory systems; therefore, we investigated the functional connectivity of PAG in PDM. Forty-six PDM subjects and 49 controls received resting-state functional magnetic resonance imaging during menstruation and periovulatory phases. The PAG of PDM subjects exhibited adaptive/reactive hyperconnectivity with the sensorimotor cortex during painful menstruation, whereas it exhibited maladaptive hypoconnectivity with the dorsolateral prefrontal cortex and default mode network (involving the ventromedial prefrontal cortex, posterior cingulate cortex, or posterior parietal cortex) during menstruation or periovulatory phase. We propose that the maladaptive descending pain modulatory systems in PDM may underpin the central susceptibility to subsequent development of various functional disorders later in life. This hypothesis is corroborated by the growing body of evidence that hypoconnectivity between PAG and default mode network is a coterminal to many functional pain disorders.