Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.
Curr Opin Psychiatry. 2012 Mar;25(2):109-13. doi: 10.1097/YCO.0b013e3283503510.
It is proposed that central rather than peripheral factors may be important in pain chronicity. We review recent empirical findings on these processes and discuss implications for treatment and prevention.
The literature on neuroimaging of pain and on learning processes shows that learning-induced functional and structural brain changes involving sensorimotor, as well as limbic and frontal, areas are important in the transition from acute to chronic pain. These alterations share many similarities with brain changes in emotional disorders and the specificity for pain needs to be determined. Further important contributors to chronic pain may be disturbed processing of the body image, impaired multisensory integration and faulty feedback from interoceptive processes. These findings have led to new treatment approaches that focus on the extinction of aversive memories, restoration of the body image and normal brain function and include approaches such as brain stimulation, mirror training, virtual reality applications or behavioral extinction training.
We propose that chronic pain is characterized by learning-related and memory-related plastic changes of the central nervous system with concomitant maladaptive changes in body perception. These alterations require new treatments that focus on the alteration of central pain memories and maladaptive body perception.
人们提出，在疼痛的慢性化过程中，中枢因素而非外周因素可能更为重要。我们回顾了这些过程的最新实证研究结果，并讨论了其对治疗和预防的意义。
有关疼痛的神经影像学和学习过程的文献表明，涉及感觉运动以及边缘和额叶区域的学习诱导的功能和结构脑变化在急性疼痛向慢性疼痛的转变中很重要。这些改变与情绪障碍中的大脑改变有许多相似之处，需要确定其对疼痛的特异性。慢性疼痛的另一个重要因素可能是身体意象处理受损、多感觉整合受损以及内感受过程的反馈错误。这些发现催生了新的治疗方法，这些方法侧重于消除厌恶记忆、恢复身体意象和正常的大脑功能，包括脑刺激、镜像训练、虚拟现实应用或行为消除训练等方法。
我们提出，慢性疼痛的特征是中枢神经系统的与学习和记忆相关的可塑性改变，同时伴有身体感知的适应不良改变。这些改变需要新的治疗方法，重点在于改变中枢疼痛记忆和适应不良的身体感知。
