Derbyshire S W G, Jones A K P, Creed F, Starz T, Meltzer C C, Townsend D W, Peterson A M, Firestone L
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15213, USA.
Neuroimage. 2002 May;16(1):158-68. doi: 10.1006/nimg.2002.1066.
Changes in regional cerebral blood flow (rCBF) have previously been demonstrated in a number of cortical and subcortical regions, including the cerebellum, midbrain, thalamus, lentiform nucleus, and the insula, prefrontal, anterior cingulate, and parietal cortices, in response to experimental noxious stimuli. Increased anterior cingulate responses in patients with chronic regional pain and depression to noxious stimulation distant from the site of clinical pain have been observed. We suggested that this may represent a generalized hyperattentional response to noxious stimuli and may apply to other types of chronic regional pain. Here these techniques are extended to a group of patients with nonspecific chronic low back pain. Thirty-two subjects, 16 chronic low back pain patients and 16 controls, were studied using positron emission tomography. Thermal stimuli, corresponding to the experience of hot, mild, and moderate pain, were delivered to the back of the subject's right hand using a thermal probe. Each subject had 12 measurements of rCBF, 4 for each stimulus. Correlation of rCBF with subjective pain experience revealed similar responses across groups in the cerebellum, midbrain (including the PAG), thalamus, insula, lentiform nucleus, and midcingulate (area 24') cortex. These regions represented the majority of activations for this study and those recorded by other imaging studies of pain. Although some small differences were observed between the groups these were not considered sufficient to suggest abnormal nociceptive processing in patients with nonspecific low back pain.
先前的研究表明，在受到实验性伤害性刺激时，包括小脑、中脑、丘脑、豆状核、脑岛、前额叶、前扣带回和顶叶皮质在内的多个皮质和皮质下区域的局部脑血流量（rCBF）会发生变化。已观察到慢性局部疼痛和抑郁症患者对远离临床疼痛部位的伤害性刺激的前扣带回反应增强。我们认为，这可能代表对伤害性刺激的一种普遍的过度关注反应，可能适用于其他类型的慢性局部疼痛。在此，这些技术被扩展应用于一组非特异性慢性下腰痛患者。使用正电子发射断层扫描对32名受试者进行了研究，其中包括16名慢性下腰痛患者和16名对照者。使用热探针将对应于热、轻度和中度疼痛体验的热刺激施加到受试者右手的背部。每个受试者进行了12次rCBF测量，每种刺激4次。rCBF与主观疼痛体验的相关性显示，在小脑、中脑（包括中脑导水管周围灰质）、丘脑、脑岛、豆状核和中扣带回（24区）皮质中，各组的反应相似。这些区域代表了本研究以及其他疼痛影像学研究记录的大部分激活区域。尽管在两组之间观察到了一些小的差异，但这些差异不足以表明非特异性下腰痛患者存在异常的伤害性处理。
