Apkarian A Vania, Sosa Yamaya, Sonty Sreepadma, Levy Robert M, Harden R Norman, Parrish Todd B, Gitelman Darren R
Department of Physiology and Institute of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
J Neurosci. 2004 Nov 17;24(46):10410-5. doi: 10.1523/JNEUROSCI.2541-04.2004.
The role of the brain in chronic pain conditions remains speculative. We compared brain morphology of 26 chronic back pain (CBP) patients to matched control subjects, using magnetic resonance imaging brain scan data and automated analysis techniques. CBP patients were divided into neuropathic, exhibiting pain because of sciatic nerve damage, and non-neuropathic groups. Pain-related characteristics were correlated to morphometric measures. Neocortical gray matter volume was compared after skull normalization. Patients with CBP showed 5-11% less neocortical gray matter volume than control subjects. The magnitude of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain. Regional gray matter density in 17 CBP patients was compared with matched controls using voxel-based morphometry and nonparametric statistics. Gray matter density was reduced in bilateral dorsolateral prefrontal cortex and right thalamus and was strongly related to pain characteristics in a pattern distinct for neuropathic and non-neuropathic CBP. Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.
大脑在慢性疼痛病症中的作用仍具有推测性。我们使用磁共振成像脑部扫描数据和自动分析技术，将26名慢性背痛（CBP）患者的脑形态与匹配的对照受试者进行了比较。CBP患者被分为神经性（因坐骨神经损伤而出现疼痛）和非神经性两组。将疼痛相关特征与形态测量指标进行关联。在颅骨归一化后比较新皮质灰质体积。CBP患者的新皮质灰质体积比对照受试者少5 - 11%。这种减少的幅度相当于正常衰老10 - 20年所损失的灰质体积。体积减少与疼痛持续时间相关，表明慢性疼痛每持续一年灰质损失1.3立方厘米。使用基于体素的形态测量法和非参数统计方法，将17名CBP患者的局部灰质密度与匹配的对照进行比较。双侧背外侧前额叶皮质和右侧丘脑的灰质密度降低，并且与神经性和非神经性CBP不同模式的疼痛特征密切相关。我们的结果表明CBP伴有脑萎缩，并提示慢性疼痛的病理生理学包括丘脑皮质过程。
