Derbyshire Stuart W G, Whalley Matthew G, Oakley David A
School of Psychology, University of Birmingham, Edgbaston, Birmingham B152TT, UK.
Eur J Pain. 2009 May;13(5):542-50. doi: 10.1016/j.ejpain.2008.06.010. Epub 2008 Jul 23.
The neuropsychological status of pain conditions such as fibromyalgia, commonly categorized as 'psychosomatic' or 'functional' disorders, remains controversial. Activation of brain structures dependent upon subjective alterations of fibromyalgia pain experience could provide an insight into the underlying neuropsychological processes. Suggestion following a hypnotic induction can readily modulate the subjective experience of pain. It is unclear whether suggestion without hypnosis is equally effective. To explore these and related questions, suggestions following a hypnotic induction and the same suggestions without a hypnotic induction were used during functional magnetic resonance imaging to increase and decrease the subjective experience of fibromyalgia pain. Suggestion in both conditions resulted in significant changes in reported pain experience, although patients claimed significantly more control over their pain and reported greater pain reduction when hypnotised. Activation of the midbrain, cerebellum, thalamus, and midcingulate, primary and secondary sensory, inferior parietal, insula and prefrontal cortices correlated with reported changes in pain with hypnotic and non-hypnotic suggestion. These activations were of greater magnitude, however, when suggestions followed a hypnotic induction in the cerebellum, anterior midcingulate cortex, anterior and posterior insula and the inferior parietal cortex. Our results thus provide evidence for the greater efficacy of suggestion following a hypnotic induction. They also indicate direct involvement of a network of areas widely associated with the pain 'neuromatrix' in fibromyalgia pain experience. These findings extend beyond the general proposal of a neural network for pain by providing direct evidence that regions involved in pain experience are actively involved in the generation of fibromyalgia pain.
纤维肌痛等疼痛病症的神经心理状态一直存在争议，这类病症通常被归类为“身心性”或“功能性”障碍。依赖纤维肌痛疼痛体验主观改变的脑结构激活，可能会为潜在的神经心理过程提供见解。催眠诱导后的暗示能够轻易调节疼痛的主观体验。尚不清楚无催眠的暗示是否同样有效。为探究这些及相关问题，在功能磁共振成像过程中，使用了催眠诱导后的暗示以及无催眠的相同暗示，以增加和减少纤维肌痛疼痛的主观体验。两种情况下的暗示均导致报告的疼痛体验有显著变化，不过患者声称在催眠时对疼痛的控制明显更多，且报告疼痛减轻程度更大。中脑、小脑、丘脑、扣带中部、初级和次级感觉区、顶下叶、脑岛和前额叶皮质的激活与催眠和非催眠暗示下报告的疼痛变化相关。然而，当暗示在小脑、前扣带中部皮质、脑岛前后部和顶下叶皮质中是在催眠诱导后给出时，这些激活的程度更大。因此，我们的结果为催眠诱导后暗示的更大功效提供了证据。它们还表明，在纤维肌痛疼痛体验中，一个与疼痛“神经矩阵”广泛相关的区域网络直接参与其中。这些发现超越了关于疼痛神经网络的一般提议，通过提供直接证据表明参与疼痛体验的区域积极参与纤维肌痛疼痛的产生。
