Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
Curr Opin Anaesthesiol. 2011 Oct;24(5):515-23. doi: 10.1097/ACO.0b013e32834a1079.
The understanding of the mechanisms underlying chronic pain is of major scientific and clinical interest. This review focuses on neuroimaging studies of pain-induced neuroplastic changes in the human brain and discusses five major categories of pain-induced neuroplastic changes.
First, peripheral or central sensitization may result in increased nociceptive input to the brain and also changes the processing of nociceptive information within the brain. Second, chronic nociceptive input from the periphery or from lesions within the central nervous system may result in cortical reorganization and maladaptive neuroplasticity within somatosensory and motor systems. Thirdly, there is evidence for pain-induced changes in large-scale neuronal network connectivity. Fourth, in patients with chronic pain, structural brain changes may occur. Finally, there is discussion that in chronic pain patients the endogenous pain-modulatory system may function aberrantly.
Recent work has substantially broadened our insights into neuroplastic changes that are involved in pain chronification. Future research will focus on the question of whether neuroimaging techniques can be used in the individual chronic pain patient as a biomarker that would allow for an objective diagnosis of different pain conditions and for the prediction of individual responses to specific therapies.
对慢性疼痛相关机制的理解具有重要的科学和临床意义。本综述重点讨论了人类大脑中与疼痛相关的神经可塑性变化的神经影像学研究，并讨论了五类与疼痛相关的神经可塑性变化。
首先，外周或中枢敏化可能导致传入大脑的伤害性输入增加，并且还改变了大脑内伤害性信息的处理。其次，来自外周或中枢神经系统内损伤的慢性伤害性输入可能导致躯体感觉和运动系统内的皮质重组和适应不良的神经可塑性。第三，有证据表明疼痛会引起大尺度神经元网络连接的变化。第四，在慢性疼痛患者中，可能会发生结构性脑变化。最后，有讨论认为，在慢性疼痛患者中，内源性疼痛调节系统可能会异常运作。
最近的研究工作大大拓宽了我们对参与疼痛慢性化的神经可塑性变化的认识。未来的研究将集中于神经影像学技术是否可以用于慢性疼痛患者个体，作为一种生物标志物，从而能够对不同的疼痛状况进行客观诊断，并预测个体对特定治疗的反应。
