Subacute Pain after Traumatic Brain Injury Is Associated with Lower Insular N-Acetylaspartate Concentrations.
Subacute Pain after Traumatic Brain Injury Is Associated with Lower Insular N-Acetylaspartate Concentrations.
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DOI：
10.1089/neu.2015.4098
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发表时间：
2016-06
影响因子：
4.2
通讯作者：
E. Widerström-Noga;V. Govind;J. Adcock;B. Levin;A. Maudsley
中科院分区：
文献类型：
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作者：
E. Widerström-Noga;V. Govind;J. Adcock;B. Levin;A. Maudsley
超过50%的创伤性脑损伤（TBI）患者会经历持续性疼痛，超过30%的患者在受伤后6周内就会出现明显的疼痛。虽然神经性疼痛是中枢神经系统损伤后的常见后果，但很少有人关注TBI后的神经性疼痛症状。TBI患者的磁共振波谱（MRS）研究显示脑内N-乙酰天冬氨酸（NAA）浓度降低，这是神经元密度和活力的标志物。虽然脑NAA减少与脊髓损伤（SCI）和糖尿病相关的神经性疼痛有关，但这种关系在TBI后尚未得到研究。本研究的主要目的是检验以下假设：参与疼痛感知和调节的脑区中较低的NAA浓度与神经性疼痛症状的严重程度相关。TBI参与者接受了体积MRS，疼痛和心理社会访谈。神经性疼痛症状量表子评分的聚类分析导致两个TBI亚组：中度神经性疼痛组（n = 17; 37.8%），与轻度或无神经性疼痛组（n = 28; 62.2%）或年龄和性别匹配的对照组（n = 45; p < 0.001）相比，岛叶NAA显著（p = 0.038）较低。控制年龄、性别和TBI后时间的分层线性回归分析显示，疼痛严重程度显著高于TBI后的疼痛程度。（F = 11.0; p < 0.001）通过较低的岛叶NAA/肌酸的组合预测（p < 0.001）、右下岛灰质体积分数（p < 0.001）、女性（p = 0.005）和老年（p = 0.039）。这些发现表明，神经元功能障碍的大脑区域参与疼痛处理与TBI后的疼痛。
Persistent pain is experienced by more than 50% of persons who sustain a traumatic brain injury (TBI), and more than 30% experience significant pain as early as 6 weeks after injury. Although neuropathic pain is a common consequence after CNS injuries, little attention has been given to neuropathic pain symptoms after TBI. Magnetic resonance spectroscopy (MRS) studies in subjects with TBI show decreased brain concentrations of N-acetylaspartate (NAA), a marker of neuronal density and viability. Although decreased brain NAA has been associated with neuropathic pain associated with spinal cord injury (SCI) and diabetes, this relationship has not been examined after TBI. The primary purpose of this study was to test the hypothesis that lower NAA concentrations in brain areas involved in pain perception and modulation would be associated with greater severity of neuropathic pain symptoms. Participants with TBI underwent volumetric MRS, pain and psychosocial interviews. Cluster analysis of the Neuropathic Pain Symptom Inventory subscores resulted in two TBI subgroups: The Moderate Neuropathic Pain (n = 17; 37.8%), with significantly (p = 0.038) lower insular NAA than the Low or no Neuropathic Pain group (n = 28; 62.2%), or age- and sex-matched controls (n = 45; p < 0.001). A hierarchical linear regression analysis controlling for age, sex, and time post-TBI showed that pain severity was significantly (F = 11.0; p < 0.001) predicted by a combination of lower insular NAA/Creatine (p < 0.001), lower right insular gray matter fractional volume (p < 0.001), female sex (p = 0.005), and older age (p = 0.039). These findings suggest that neuronal dysfunction in brain areas involved in pain processing is associated with pain after TBI.