Howard Matthew A, Sanders Duncan, Krause Kristina, O'Muircheartaigh Jonathan, Fotopoulou Aikaterini, Zelaya Fernando, Thacker Michael, Massat Nathalie, Huggins John P, Vennart William, Choy Ernest, Daniels Maxine, Williams Steven C R
King's College London, London, UK.
Arthritis Rheum. 2012 Dec;64(12):3936-46. doi: 10.1002/art.37685.
Increasing evidence suggests a central nervous system (CNS) component underpinning persistent pain disease states. This study was undertaken to determine regional cerebral blood flow (rCBF) changes representing ongoing pain experienced by patients with painful osteoarthritis (OA) of the carpometacarpal (CMC) joint and to examine rCBF variability across sessions. We used pulsed continuous arterial spin labeling (pCASL), a perfusion magnetic resonance imaging (MRI) technique.
The study included 16 patients with CMC OA and 17 matched controls. Two pCASL scans and numerical rating scale (NRS) estimates of ongoing pain were acquired in each of two identical sessions. Voxelwise general linear model analyses were performed to determine rCBF differences between OA and control groups, rCBF differences between sessions within each group, and whether sessionwise rCBF differences were related to variability in perceived ongoing pain.
In the OA group, rCBF increases representing ongoing pain were identified in the primary and secondary somatosensory, insula, and cingulate cortices; thalamus; amygdala; hippocampus; and dorsal midbrain/pontine tegmentum, including the periaqueductal gray/nucleus cuneiformis. Sessionwise rCBF differences in the OA group in the postcentral, rostral/subgenual cingulate, mid/anterior insula, prefrontal, and premotor cortices were related to changes in perceived ongoing pain. No significant sessionwise rCBF differences were observed in controls.
This is the first quantitative endogenous perfusion MRI study of the cerebral representation of ongoing, persistent pain due to OA. Observed rCBF changes potentially indicate dysregulated CNS appraisal and modulation of pain, most likely the maladaptive neuroplastic sequelae of living with painful OA. Understanding the neural basis of ongoing pain is likely to be important in developing novel treatment strategies.
越来越多的证据表明，中枢神经系统（CNS）在持续性疼痛疾病状态中起着重要作用。本研究旨在确定代表掌指关节（CMC）疼痛性骨关节炎（OA）患者所经历的持续性疼痛的局部脑血流量（rCBF）变化，并检查各 sessions 间 rCBF 的变异性。我们使用了脉冲式连续动脉自旋标记（pCASL），这是一种灌注磁共振成像（MRI）技术。
该研究纳入了 16 例 CMC OA 患者和 17 例匹配的对照组。在两个相同的 sessions 中，分别对每位受试者进行了两次 pCASL 扫描以及对持续性疼痛的数字评分量表（NRS）评估。进行了体素水平的一般线性模型分析，以确定 OA 组和对照组之间的 rCBF 差异、每组内各 sessions 之间的 rCBF 差异，以及各 session 的 rCBF 差异是否与感知到的持续性疼痛的变异性相关。
在 OA 组中，在初级和次级体感皮层、岛叶、扣带回皮层、丘脑、杏仁核、海马体以及背侧中脑/脑桥被盖区，包括导水管周围灰质/楔状核，发现了代表持续性疼痛的 rCBF 增加。OA 组在中央后回、喙部/膝下扣带回、中/前岛叶、前额叶和运动前区皮层的各 session 的 rCBF 差异与感知到的持续性疼痛的变化有关。在对照组中未观察到各 session 间显著的 rCBF 差异。
这是第一项关于 OA 所致持续性疼痛的脑表征的定量内源性灌注 MRI 研究。观察到的 rCBF 变化可能表明中枢神经系统对疼痛的评估和调节失调，很可能是疼痛性 OA 患者适应不良的神经可塑性后遗症。了解持续性疼痛的神经基础可能对开发新的治疗策略很重要。
