Altered pain processing in veterans with posttraumatic stress disorder
Altered pain processing in veterans with posttraumatic stress disorder
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DOI：
10.1001/archpsyc.64.1.76
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
Schmahl, Christian
中科院分区：
文献类型：
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作者：
Geuze, Elbert;Westenberg, Herman G. M.;Schmahl, Christian
背景：创伤后应激障碍（PTSD）是一种慢性的、使人衰弱的焦虑症。与疼痛处理相关的几个大脑区域与PTSD有关。据我们所知，没有功能成像研究讨论了是否与PTSD患者的经验和过程中的疼痛以不同的方式比controlsubjects.Objective：研究神经相关的疼痛处理PTSD.Design患者：实验过程包括心理物理评估和功能磁共振成像神经成像。在两个实验组中，在功能性磁共振成像期间评估两种条件，一种条件是施用43摄氏度的固定温度（固定温度条件）和另一种条件，每名受试者有一个单独的温度，但有一个类似的情感标签，相当于主观疼痛强度的40（个体温度条件）。设置：军事精神病学部门的学术门诊单位与精神病医院的成像中心合作。参与者：招募了12名患有PTSD的男性退伍军人和12名没有PTSD的男性退伍军人，并在年龄、部署地区和部署年份方面进行匹配。功能性磁共振成像血氧水平依赖性对热刺激的反应的变化，反映了参与疼痛处理的脑区活动的增加和减少。与对照组相比，PTSD患者将固定温度评估中的温度评定为疼痛程度较低。在固定温度条件下，PTSD患者左侧海马激活增加，双侧腹外侧前额叶皮层和右侧杏仁核激活减少。在个人的温度条件下，PTSD患者表现出增加激活的右侧壳核和双侧杏仁核，以及减少活动的右侧中央前回和右amygdala.Conclusions：这些数据提供了证据，减少疼痛敏感性PTSD。目击神经激活模式被认为与PTSD患者疼痛处理的改变有关。
Context: Posttraumatic stress disorder ( PTSD) is a chronic and debilitating anxiety disorder. Several brain areas related to pain processing are implicated in PTSD. To our knowledge, no functional imaging study has discussed whether patients with PTSD experience and process pain in a different way than control subjects.Objective: To examine neural correlates of pain processing in patients with PTSD.Design: The experimental procedure consisted of psychophysical assessment and neuroimaging with functional magnetic resonance imaging. Two conditions were assessed during functional magnetic resonance imaging in both experimental groups, one condition with administration of a fixed temperature of 43 degrees C ( fixed-temperature condition) and the other condition with an individual temperature for each subject but with a similar affective label equaling 40% of the subjective pain intensity ( individual temperature condition).Setting: Academic outpatient unit in a department of military psychiatry in collaboration with an imaging center at a psychiatric hospital.Participants: Twelve male veterans with PTSD and 12 male veterans without PTSD were recruited and matched for age, region of deployment, and year of deployment.Main Outcome Measures: Changes in functional magnetic resonance imaging blood oxygenation level-dependent response to heat stimuli, reflecting increased and decreased activity of brain areas involved in pain processing.Results: Patients with PTSD rated temperatures in the fixed-temperature assessment as less painful compared with controls. In the fixed-temperature condition, patients with PTSD revealed increased activation in the left hippocampus and decreased activation in the bilateral ventrolateral prefrontal cortex and the right amygdala. In the individual temperature condition, patients with PTSD showed increased activation in the right putamen and bilateral insula, as well as decreased activity in the right precentral gyrus and the right amygdala.Conclusions: These data provide evidence for reduced pain sensitivity in PTSD. The witnessed neural activation pattern is proposed to be related to altered pain processing in patients with PTSD.