Chen A C
Aalborg University, Aalborg, Denmark.
Int J Psychophysiol. 2001 Oct;42(2):147-59. doi: 10.1016/s0167-8760(01)00163-5.
With the maturation of EEG/MEG brain mapping and PET/fMRI neuroimaging in the 1990s, greater understanding of pain processing in the brain now elucidates and may even challenge the classical theory of pain mechanisms. This review scans across the cultural diversity of pain expression and modulation in man. It outlines the difficulties in defining and studying human pain. It then focuses on methods of studying the brain in experimental and clinical pain, the cohesive results of brain mapping and neuroimaging of noxious perception, the implication of pain research in understanding human consciousness and the relevance to clinical care as well as to the basic science of human psychophysiology. Non-invasive brain studies in man start to unveil the age-old puzzles of pain-illusion, hypnosis and placebo in pain modulation. The neurophysiological and neurohemodynamic brain measures of experimental pain can now largely satisfy the psychophysiologist's dream, unimaginable only a few years ago, of modelling the body-brain, brain-mind, mind-matter duality in an inter-linking 3-P triad: physics (stimulus energy); physiology (brain activities); and psyche (perception). For neuropsychophysiology greater challenges lie ahead: (a) how to integrate a cohesive theory of human pain in the brain; (b) what levels of analyses are necessary and sufficient; (c) what constitutes the structural organisation of the pain matrix; (d) what are the modes of processing among and across the sites of these structures; and (e) how can neural computation of these processes in the brain be carried out? We may envision that modular identification and delineation of the arousal-attention, emotion-motivation and perception-cognition neural networks of pain processing in the brain will also lead to deeper understanding of the human mind. Two foreseeable impacts on clinical sciences and basic theories from brain mapping/neuroimaging are the plausible central origin in persistent pain and integration of sensory-motor function in pain perception.
随着脑电图/脑磁图以及正电子发射断层扫描/功能磁共振成像等神经影像学技术在20世纪90年代逐渐成熟，如今人们对大脑疼痛处理机制有了更深入的理解，这甚至可能对经典的疼痛机制理论构成挑战。这篇综述审视了人类疼痛表达和调节的文化多样性。它概述了定义和研究人类疼痛的困难之处。接着重点讨论了在实验性和临床性疼痛中研究大脑的方法、疼痛感知的脑图谱和神经影像学的连贯结果、疼痛研究在理解人类意识方面的意义以及与临床护理和人类心理生理学基础科学的相关性。对人类进行的非侵入性脑研究开始揭示疼痛幻觉、催眠和疼痛调节中安慰剂效应这些由来已久的谜题。实验性疼痛的神经生理学和神经血流动力学脑部测量如今在很大程度上实现了心理生理学家的梦想，就在几年前这还是无法想象的，即在一个相互关联的三维三元组中模拟身体 - 大脑、大脑 - 心智、心智 - 物质的二元性：物理学（刺激能量）；生理学（大脑活动）；以及心理（感知）。对于神经心理生理学而言，更大的挑战还在前方：（a）如何整合大脑中关于人类疼痛的连贯理论；（b）哪些分析层次是必要且充分的；（c）疼痛矩阵的结构组织是什么；（d）这些结构部位之间以及跨越这些部位的处理模式是什么；以及（e）大脑中这些过程的神经计算是如何进行的？我们可以设想，对大脑中疼痛处理的唤醒 - 注意力、情绪 - 动机以及感知 - 认知神经网络进行模块化识别和描绘，也将有助于更深入地理解人类心智。脑图谱/神经影像学对临床科学和基础理论的两个可预见影响是持续性疼痛可能源于中枢以及疼痛感知中感觉 - 运动功能的整合。
