Becerra Lino, Morris Susie, Bazes Shelly, Gostic Richard, Sherman Seth, Gostic Julie, Pendse Gautam, Moulton Eric, Scrivani Steven, Keith David, Chizh Boris, Borsook David
Pain and Analgesia Imaging and Neuroscience Group, Department of Psychiatry, McLean Hospital, Belmont, Massachusetts 02478, USA.
J Neurosci. 2006 Oct 18;26(42):10646-57. doi: 10.1523/JNEUROSCI.2305-06.2006.
Functional magnetic resonance imaging was used to study patients with chronic neuropathic pain involving the maxillary region (V2) of the trigeminal nerve in patients with spontaneous pain and evoked pain to brush (allodynia). Patients underwent two functional scans (2-3 months apart) with mechanical and thermal stimuli applied to the affected region of V2 and to the mirror site in the unaffected contralateral V2 region, as well as bilaterally to the mandibular (V3) division. Patients were stimulated with brush, noxious cold, and noxious heat. Significant changes were observed in regions within and outside the primary trigeminal sensory pathway. Stimulation to the affected (neuropathic) side resulted in predominantly frontal region and basal ganglia activation compared with the control side. The differences were consistent with the allodynia to brush and cold. A region of interest-based analysis of the trigeminal sensory pathway revealed patterns of activation that differentiated between the affected and unaffected sides and that were particular to each stimulus. Activation in the spinal trigeminal nucleus was constant in location for all pain stimuli. Activation in other brainstem nuclei also showed differences in the blood oxygenation level-dependent signal for the affected versus the unaffected side. Thus, sensory processing in patients with trigeminal neuropathic pain is associated with distinct activation patterns consistent with sensitization within and outside of the primary sensory pathway.
功能磁共振成像被用于研究三叉神经上颌区域（V2）慢性神经性疼痛患者的自发痛和刷擦诱发痛（痛觉过敏）。患者接受两次功能扫描（间隔2 - 3个月），对V2的患侧区域以及未受影响的对侧V2区域的镜像部位施加机械和热刺激，同时对双侧下颌（V3）分支也进行刺激。用刷子、冷刺激和热刺激对患者进行刺激。在原发性三叉神经感觉通路内外的区域观察到显著变化。与对照侧相比，刺激患（神经病变）侧主要导致额叶区域和基底神经节激活。这些差异与对刷擦和冷刺激的痛觉过敏一致。基于感兴趣区域的三叉神经感觉通路分析揭示了患侧和未患侧之间不同的激活模式，且每种刺激都有其特定模式。所有疼痛刺激下，三叉神经脊束核的激活位置恒定。其他脑干核团的激活在患侧和未患侧的血氧水平依赖信号方面也存在差异。因此，三叉神经性疼痛患者的感觉处理与原发性感觉通路内外的敏化相关的独特激活模式有关。
