Rodriguez-Raecke Rea, Niemeier Andreas, Ihle Kristin, Ruether Wolfgang, May Arne
Department of Systems Neuroscience and Orthopaedics, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
J Neurosci. 2009 Nov 4;29(44):13746-50. doi: 10.1523/JNEUROSCI.3687-09.2009.
Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were reported in patients suffering from chronic pain. Although some authors discussed these findings as damage or loss of brain gray matter, one of the key questions is whether these structural alterations in the cerebral pain-transmitting network precede or succeed the chronicity of pain. We investigated 32 patients with chronic pain due to primary hip osteoarthritis and found a characteristic gray matter decrease in patients compared with controls in the anterior cingulate cortex (ACC), right insular cortex and operculum, dorsolateral prefrontal cortex (DLPFC), amygdala, and brainstem. We then investigated a subgroup of these patients (n = 10) 6 weeks and 4 months after total hip replacement surgery, monitoring whole brain structure. After surgery, all 10 patients were completely pain free and we observed a gray matter increase in the DLPFC, ACC, amygdala, and brainstem. As gray matter decrease is at least partly reversible when pain is successfully treated, we suggest that the gray matter abnormalities found in chronic pain do not reflect brain damage but rather are a reversible consequence of chronic nociceptive transmission, which normalizes when the pain is adequately treated.
最近，有报道称慢性疼痛患者大脑中可归因于疼痛传递区域出现了局部形态学改变。尽管一些作者将这些发现视为脑灰质的损伤或丢失，但关键问题之一是，大脑疼痛传递网络中的这些结构改变是先于还是后于疼痛的慢性化出现。我们对32例因原发性髋骨关节炎导致慢性疼痛的患者进行了研究，发现与对照组相比，患者在前扣带回皮质（ACC）、右侧岛叶皮质及岛盖、背外侧前额叶皮质（DLPFC）、杏仁核和脑干存在特征性灰质减少。然后，我们对这些患者中的一个亚组（n = 10）在全髋关节置换手术后6周和4个月进行了研究，监测全脑结构。术后，所有10例患者均完全无痛，我们观察到DLPFC、ACC、杏仁核和脑干的灰质增加。由于当疼痛得到成功治疗时，灰质减少至少部分是可逆的，我们认为在慢性疼痛中发现的灰质异常并不反映脑损伤，而是慢性伤害性传递的可逆后果，当疼痛得到充分治疗时会恢复正常。
