Grachev I D, Fredrickson B E, Apkarian A V
Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, NY, USA.
J Neural Transm (Vienna). 2002 Oct;109(10):1309-34. doi: 10.1007/s00702-002-0722-7.
The neurobiology of the interaction between pain and anxiety is unknown. The present study examined interrelationships between: regional brain chemistry (as identified by in vivo proton magnetic resonance spectroscopy [(1)H-MRS] in dorsolateral prefrontal cortex [DLPFC], orbitofrontal cortex [OFC], cingulate and thalamus), pain (as measured by short form of the McGill Pain Questionnaire [SF-MPQ]), and anxiety (measured by the State-Trait Anxiety Inventory) in chronic low back pain (CLBP) patients, and contrasted to the relationship between brain chemistry and anxiety in sex and age-matched normal subjects. The results show that brain chemistry depends on a 3-way interaction of brain regions examined, subject groups (normal vs. CLBP), and anxiety levels (high vs. low). The concentration of N-Acetyl aspartate (the largest peak in (1)H-MRS) in OFC could distinguish between anxiety levels and between subject groups. Chemical-perceptual relationships were analyzed by calculating correlations between regional chemicals and perceptual measures of pain and anxiety. To isolate pain from anxiety, these maps were subdivided based on anxiety and, in the CLBP patients along anxiety-more-related vs. anxiety-less-related pain descriptors and along sensory vs. affective pain descriptors. There was a precise relationship between perception and brain chemistry. The chemical-perceptual network best related to pain in CLBP patients was comprised of the DLPFC and OFC; the chemical-anxiety network was best related to the OFC chemistry in normals and to all four regions studied in CLBP patients; and the cingulate was best related to the affective component of pain. We conclude that the chemical-perceptual mapping differentiates between closely related perceptual states of pain and anxiety in chronic pain and provides a brain regional-chemical-perceptual description of the long-term reorganization that occurs with chronic pain.
疼痛与焦虑之间相互作用的神经生物学机制尚不清楚。本研究探讨了以下因素之间的相互关系：区域脑化学（通过活体质子磁共振波谱 [(1)H-MRS] 在背外侧前额叶皮质 [DLPFC]、眶额皮质 [OFC]、扣带回和丘脑进行识别）、疼痛（通过麦吉尔疼痛问卷简表 [SF-MPQ] 测量）以及慢性下腰痛（CLBP）患者的焦虑（通过状态-特质焦虑量表测量），并与性别和年龄匹配的正常受试者的脑化学与焦虑之间的关系进行对比。结果表明，脑化学取决于所检查的脑区、受试者组（正常与CLBP）以及焦虑水平（高与低）这三者之间的相互作用。OFC中N-乙酰天门冬氨酸（(1)H-MRS中最大的峰）的浓度能够区分焦虑水平以及受试者组。通过计算区域化学物质与疼痛和焦虑的感知测量之间的相关性来分析化学感知关系。为了将疼痛与焦虑区分开来，这些图谱根据焦虑进行了细分，在CLBP患者中还沿着与焦虑相关性较高和较低的疼痛描述词以及沿着感觉性与情感性疼痛描述词进行了细分。感知与脑化学之间存在精确的关系。与CLBP患者疼痛最相关的化学感知网络由DLPFC和OFC组成；化学焦虑网络在正常受试者中与OFC化学最相关，在CLBP患者中与所研究的所有四个区域最相关；扣带回与疼痛的情感成分最相关。我们得出结论，化学感知图谱能够区分慢性疼痛中密切相关的疼痛和焦虑感知状态，并提供了慢性疼痛发生时长期重组的脑区-化学-感知描述。
