Gündel H, Valet M, Sorg C, Huber D, Zimmer C, Sprenger T, Tölle T R
Abteilung Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg - Str. 1, 30625 Hannover, Germany Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Germany Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Germany Klinik und Poliklinik für Psychosomatische Medizin, Psychotherapie und Med. Psychologie, Klinikum rechts der Isar, Technische Universität München, Germany Abteilung für Neuroradiologie, Institut für Röntgendiagnostik, Klinikum rechts der Isar, Technische Universität München, Germany.
Pain. 2008 Jul 15;137(2):413-421. doi: 10.1016/j.pain.2007.10.003. Epub 2007 Nov 19.
Idiopathic chronic pain conditions with a mismatch between anatomical abnormalities and symptoms can be categorized as somatoform pain disorder according to the DSM-IV criteria. A dysfunction of pain processing circuits has been suggested as one underlying pathophysiological factor. There is accumulating evidence for a crucial role of affect regulating brain structures such as the medial frontal cortex in this context. We investigated the cerebral processing of noxious heat stimuli as objective marker for pain sensation in 12 right handed women with somatoform pain disorder fulfilling DSM-IV criteria and 13 age-matched healthy volunteers using functional MRI. The average ratings for experimentally induced pain were not significantly different between controls and patients concerning pain intensity and pain unpleasantness. Comparing patients with controls a pain related hypoactive state of the ventromedial prefrontal/orbitofrontal cortex (BA 10/11) and a hyperactive state of the parahippocampal gyrus, amygdala and anterior insula were found in the patient group. Our findings of an altered cerebral processing of experimentally induced pain in patients with somatoform pain disorder support the hypothesis of dysfunctional pain processing, especially in affect regulating regions.
根据《精神疾病诊断与统计手册》第四版标准，解剖学异常与症状不匹配的特发性慢性疼痛病症可归类为躯体形式疼痛障碍。疼痛处理回路功能障碍被认为是一种潜在的病理生理因素。在这种情况下，越来越多的证据表明情感调节脑结构（如内侧额叶皮质）起着关键作用。我们使用功能磁共振成像，对12名符合《精神疾病诊断与统计手册》第四版标准的患有躯体形式疼痛障碍的右利手女性和13名年龄匹配的健康志愿者进行了研究，将有害热刺激的大脑处理作为疼痛感觉的客观指标。在疼痛强度和疼痛不适感方面，对照组和患者组对实验诱导疼痛的平均评分没有显著差异。将患者与对照组进行比较，发现患者组腹内侧前额叶/眶额叶皮质（BA 10/11）存在与疼痛相关的低激活状态，而海马旁回、杏仁核和前岛叶存在高激活状态。我们关于躯体形式疼痛障碍患者实验诱导疼痛的大脑处理改变的研究结果支持了疼痛处理功能障碍的假设，尤其是在情感调节区域。
