Cerebral responses to pain in patients suffering acute post-dental extraction pain measured by positron emission tomography (PET)
Cerebral responses to pain in patients suffering acute post-dental extraction pain measured by positron emission tomography (PET)
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DOI：
10.1053/eujp.1998.0102
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发表时间：
1999-01-01
影响因子：
3.6
通讯作者：
Harris, M
中科院分区：
文献类型：
--
作者：
Derbyshire, SWG;Jones, AKP;Harris, M
以前对正常志愿者的研究表明，在一个结构网络中，对实验性热痛的皮层反应是分布式的。该网络包括岛叶、前扣带回、前额叶、下顶叶和体感皮质。患有类风湿性关节炎（RA）后慢性伤害性疼痛的患者对施加到右手背部的实验性热痛表现出阻尼的中枢反应。在这项研究中，急性，左侧，磨牙拔除（手术）后疼痛的患者，我们评估了皮质反应的实验性热痛，适用于右手背，使用正电子发射断层扫描（PET），并与以前报道的对照组和RA组的反应进行比较。在对实验性热痛的反应中，手术组表明与热刺激同侧的前额叶皮层[Brodman区（BA）44]的局部脑血流量显著增加。在壳核和颞横回（BA 40/41/42）中检测到同侧增加，岛叶皮质双侧增加。与对照组和RA组相比，前扣带回（BA 24）、前额叶内侧和眶额（BA 9/10/32/47）皮质的反应显著降低。这些结果表明，大脑皮层的相对离散的区域负责急性炎症发作期间的急性伤害性处理。在急性炎性疼痛（左颌）期间，对实验性热痛（施加于右手）的额叶和前扣带反应降低，说明了伤害性处理的皮质调制，其可能与对这些区域的非躯体定位的、双侧的伤害性输入有关。
Previous studies with normal volunteers have demonstrated distributed cortical responses to experimental heat pain within a network of structures. The network includes the insula, anterior cingulate: prefrontal, inferior parietal and somatosensory cortices. Patients suffering from chronic nociceptive pain following rheumatoid arthritis (RA) have shown damped central responses to experimental heat pain applied to the back of the right hand. In this study of patients with acute, left-sided, post-molar-extraction (surgical) pain, we assessed the cortical responses to experimental heat pain, applied to the back of the right hand, using positron emission tomography (PET), and compared the responses with a previously reported control group and the RA group. In response to the experimental heat pain, the surgical group indicated significantly increased regional cerebral blood flow in the prefrontal cortex [Brodman's area (BA) 44] ipsilateral to the heat stimulus. Contralateral increases were detected in the putamen and transverse temporal gyrus (BA 40/41/42) with bilateral increases in the insular cortex. Compared to the control and RA group, there were significantly reduced responses in the anterior cingulate (BA 24), pre-frontal medial, and orbito-frontal (BA 9/10/32/47) cortices. These results suggest that relatively discrete regions of the cerebral cortex are responsible for acute nociceptive processing during an acute inflammatory episode. The reduced frontal and anterior cingulate responses to the experimental heat pain (applied to the right hand) during acute inflammatory pain (left jaw) illustrates cortical modulation of nociceptive processing that may be related to non-somatotopic, bilateral, nociceptive inputs to these areas.