Center for Neurosensory Disorders, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599, USA.
Best Pract Res Clin Rheumatol. 2011 Apr;25(2):271-84. doi: 10.1016/j.berh.2011.02.003.
The primary symptom of fibromyalgia is widespread pain. This symptom is accompanied by secondary symptoms, such as cognitive difficulties and sensitivity to painful stimulation, and by numerous co-morbidities. The first neuroimaging studies addressed the primary symptom by examining differences between patients and controls using single-photon-emission-computed tomography (SPECT). Subsequent studies focussed on the secondary symptom of increased sensitivity to painful stimulation. Functional MRI (fMRI) studies using the blood-oxygen-level-dependent (BOLD) method to assess brain activation demonstrated augmented sensitivity to painful pressure and the association of this augmentation with variables such as depression and catastrophising. These studies have also assessed brain processes associated with cognitive dysfunction. Neuroimaging studies of fibromyalgia have now come full circle, using new techniques to provide information about differences that may relate to underlying mechanisms and the primary symptom of widespread pain. Using a wide array of techniques, these studies have found differences in opioid receptor binding, concentration of metabolites associated with neural processing in pain-related regions and differences in functional brain networks and in regional brain volume and in white-matter tracks. This array of neuroimaging techniques continues to provide increasing information about supraspinal mechanisms associated with fibromyalgia that will aid in diagnosis, including identification of diagnostic subgroups, the development of new efficacious treatments that address both causes and symptoms and the matching of patients to treatments.
纤维肌痛的主要症状是广泛疼痛。该症状伴有认知困难和对疼痛刺激的敏感性等次要症状，以及许多合并症。最初的神经影像学研究通过使用单光子发射计算机断层扫描（SPECT）检查患者与对照组之间的差异来解决主要症状。随后的研究集中在对疼痛刺激敏感性增加的次要症状上。使用血氧水平依赖（BOLD）方法评估大脑激活的功能性磁共振成像（fMRI）研究表明，对疼痛压力的敏感性增加，并且这种增加与抑郁和灾难化等变量相关。这些研究还评估了与认知功能障碍相关的大脑过程。纤维肌痛的神经影像学研究现在已经完成了一个循环，使用新技术提供可能与潜在机制和广泛疼痛的主要症状相关的差异信息。这些研究使用了一系列技术，发现了阿片受体结合、与疼痛相关区域神经处理相关的代谢物浓度、功能大脑网络以及区域大脑体积和白质轨迹的差异。这一系列神经影像学技术继续提供有关与纤维肌痛相关的中枢神经系统机制的越来越多的信息，这将有助于诊断，包括确定诊断亚组、开发既能解决病因又能解决症状的新有效治疗方法以及将患者与治疗方法相匹配。
