Kupers Ron, Faymonville Marie-Elisabeth, Laureys Steven
Center for Functionally Integrative Neuroscience (CFIN), Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Prog Brain Res. 2005;150:251-69. doi: 10.1016/S0079-6123(05)50019-0.
Nowadays, there is compelling evidence that there is a poor relationship between the incoming sensory input and the resulting pain sensation. Signals coming from the peripheral nervous system undergo a complex modulation by cognitive, affective, and motivational processes when they enter the central nervous system. Placebo- and hypnosis-induced analgesia form two extreme examples of how cognitive processes may influence the pain sensation. With the advent of modern brain imaging techniques, researchers have started to disentangle the brain mechanisms involved in these forms of cognitive modulation of pain. These studies have shown that the prefrontal and anterior cingulate cortices form important structures in a descending pathway that modulates incoming sensory input, likely via activation of the endogenous pain modulatory structures in the midbrain periaqueductal gray. Although little is known about the receptor systems involved in hypnosis-induced analgesia, studies of the placebo response suggest that the opiodergic and dopaminergic systems play an important role in the mediation of the placebo response.
如今,有确凿的证据表明,传入的感觉输入与产生的痛觉之间的关系并不紧密。来自外周神经系统的信号在进入中枢神经系统时,会受到认知、情感和动机过程的复杂调节。安慰剂诱导镇痛和催眠诱导镇痛是认知过程如何影响痛觉的两个极端例子。随着现代脑成像技术的出现,研究人员已开始厘清参与这些痛觉认知调节形式的脑机制。这些研究表明,前额叶皮质和前扣带回皮质在一条下行通路中形成重要结构,该通路可能通过激活中脑导水管周围灰质中的内源性痛觉调制结构来调节传入的感觉输入。尽管对于催眠诱导镇痛所涉及的受体系统知之甚少,但对安慰剂反应的研究表明,阿片能系统和多巴胺能系统在安慰剂反应的介导中起重要作用。
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