Fomberstein Kenneth, Qadri Saeeda, Ramani Ramachandran
Yale University School of Medicine, New Haven, Connecticut, USA.
Curr Opin Anaesthesiol. 2013 Oct;26(5):588-93. doi: 10.1097/01.aco.0000433060.59939.fe.
This article reviews the current state of knowledge in functional MRI (fMRI) research related to pain with primary focus on clinical studies.
With fMRI, the subjective effects of pain (sensory, affect, emotion, and motor components) can be objectively imaged. Although the conventional fMRI technique has been the isolation of regions in the brain transmitting and modulating pain, functional connectivity measurement can identify functionally linked regions associated with pain processing. The primary and secondary somatosensory cortex (S1 and S2), anterior cingulate cortex (ACC), and insula are the four regions (part of pain matrix) consistently activated in pain states. Functional connectivity between the prefrontal cortex (PFC), ACC, and insula correlates well with clinical pain measures. The dorsal medial PFC to insula connectivity can identify patients prone to persistent back pain. Default mode network (DMN) to insula connectivity is associated with spontaneous pain in fibromyalgia patients. In addition, the DMN encompasses the PFC. Techniques for fMRI analysis, templates, and standards for identifying the functional networks in the brain are evolving continuously. The activation pattern with analgesic agents seems to be specific to the class of drugs.
As we learn more about fMRI related to pain, functional connectivity patterns could emerge as biomarkers for specific pain conditions.
本文回顾了功能磁共振成像（fMRI）在疼痛研究方面的当前知识状态，主要聚焦于临床研究。
利用fMRI，可以对疼痛的主观效应（感觉、情感、情绪和运动成分）进行客观成像。尽管传统的fMRI技术一直致力于分离大脑中传递和调节疼痛的区域，但功能连接测量能够识别与疼痛处理相关的功能连接区域。初级和次级体感皮层（S1和S2）、前扣带回皮层（ACC）以及脑岛是在疼痛状态下持续被激活的四个区域（疼痛矩阵的一部分）。前额叶皮层（PFC）、ACC和脑岛之间的功能连接与临床疼痛测量结果高度相关。背内侧前额叶皮层与脑岛之间的连接能够识别出易患持续性背痛的患者。默认模式网络（DMN）与脑岛之间的连接与纤维肌痛患者的自发疼痛相关。此外，DMN包含PFC。用于fMRI分析的技术、模板以及识别大脑功能网络的标准正在不断发展。镇痛药物的激活模式似乎因药物类别而异。
随着我们对与疼痛相关的fMRI了解得越来越多，功能连接模式可能会成为特定疼痛状况的生物标志物。
