条件性安慰剂镇痛的神经基础。

Neural bases of conditioned placebo analgesia.

机构信息

Dipartimento di Scienze Biomediche, Univ. Modena e Reggio Emilia, Via Campi 287, I-41125 Modena, Italy Dipartimento di Neuroscienze, Univ. Torino, Istituto Nazionale di Neuroscienze, Corso Raffaello 30, I-10125 Torino, Italy Dipartimento di Scienze e Tecnologie Biomediche, Univ. Udine, P.le Kolbe 4, I-33100 Udine, Italy.

出版信息

Pain. 2010 Dec;151(3):816-824. doi: 10.1016/j.pain.2010.09.021. Epub 2010 Oct 12.

Abstract

Despite growing interest in the placebo effect, the neural correlates of conditioned analgesia are still incompletely understood. We investigated herein on brain activity during the conditioning and post-conditioning phases of a placebo experimental paradigm, using event-related fMRI in 31 healthy volunteers. Brief laser heat stimuli delivered to one foot (either right or left) were preceded by different visual cues, signalling either painful stimuli alone, or painful stimuli accompanied by a (sham) analgesic procedure. Cues signalling the analgesic procedure were followed by stimuli of lower intensity in the conditioning session, whereas in the test session both cues were followed by painful stimuli of the same intensity. During the first conditioning trials, progressive signal increases over time were found during anticipation of analgesia compared to anticipation of pain, in a medial prefrontal focus centered on medial area BA8, and in bilateral lateral prefrontal foci. These frontal foci were adjacent to, and partially overlapped, those active during anticipation of analgesia in the test session, whose signal changes were related to the magnitude of the placebo behavioral response, and those active during placebo analgesia. Specifically, a large focus in the right prefrontal cortex showed activity related to analgesia, irrespective of the expected side of stimulation. Analgesia was also related to decreased activity, detectable immediately following noxious stimulation, in parietal, insular and cingulate pain-related clusters. Our findings of dynamic changes in prefrontal areas during placebo conditioning, and of direct placebo effects on cortical nociceptive processing, add new insights into the neural bases of conditioned placebo analgesia.

摘要

尽管人们对安慰剂效应越来越感兴趣,但条件性镇痛的神经相关性仍不完全清楚。我们使用事件相关 fMRI 在 31 名健康志愿者中研究了一种安慰剂实验范式的条件和后条件阶段的大脑活动。短暂的激光热刺激施加于一只脚(无论是右脚还是左脚),并伴随着不同的视觉提示,分别表示只有疼痛刺激,或疼痛刺激伴随着(假)镇痛程序。提示镇痛程序的提示在条件阶段之后会接收到强度较低的刺激,而在测试阶段,两个提示之后都会接收到相同强度的疼痛刺激。在第一次条件试验中,与预期疼痛相比,在预期镇痛时发现了随时间推移的信号逐渐增加,在以中线 BA8 为中心的内侧前额叶焦点和双侧外侧前额叶焦点中发现了这种情况。这些额叶焦点与测试阶段中预期镇痛时的活跃焦点相邻且部分重叠,其信号变化与安慰剂行为反应的幅度有关,与安慰剂镇痛时的活跃焦点有关。具体来说,右前额叶皮层的一个大焦点显示出与镇痛相关的活动,而与预期刺激的侧无关。镇痛还与在疼痛相关的顶叶、岛叶和扣带回集群中立即检测到的疼痛刺激后活动减少有关。我们在安慰剂条件作用期间发现前额叶区域的动态变化,以及皮质伤害性处理的直接安慰剂效应,为条件性安慰剂镇痛的神经基础提供了新的见解。

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