Feinstein Justin S, Khalsa Sahib S, Salomons Tim V, Prkachin Kenneth M, Frey-Law Laura A, Lee Jennifer E, Tranel Daniel, Rudrauf David
Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA.
Department of Psychology, University of Iowa, Iowa City, IA, 52242, USA.
Brain Struct Funct. 2016 Apr;221(3):1499-511. doi: 10.1007/s00429-014-0986-3. Epub 2015 Jan 11.
Functional neuroimaging investigations of pain have discovered a reliable pattern of activation within limbic regions of a putative "pain matrix" that has been theorized to reflect the affective dimension of pain. To test this theory, we evaluated the experience of pain in a rare neurological patient with extensive bilateral lesions encompassing core limbic structures of the pain matrix, including the insula, anterior cingulate, and amygdala. Despite widespread damage to these regions, the patient's expression and experience of pain was intact, and at times excessive in nature. This finding was consistent across multiple pain measures including self-report, facial expression, vocalization, withdrawal reaction, and autonomic response. These results challenge the notion of a "pain matrix" and provide direct evidence that the insula, anterior cingulate, and amygdala are not necessary for feeling the suffering inherent to pain. The patient's heightened degree of pain affect further suggests that these regions may be more important for the regulation of pain rather than providing the decisive substrate for pain's conscious experience.
对疼痛的功能性神经影像学研究发现，在一个假定的“疼痛矩阵”的边缘区域内存在一种可靠的激活模式，从理论上讲，这种模式反映了疼痛的情感维度。为了验证这一理论，我们评估了一位罕见的神经系统疾病患者的疼痛体验，该患者双侧广泛病变，累及疼痛矩阵的核心边缘结构，包括脑岛、前扣带回和杏仁核。尽管这些区域受到广泛损伤，但患者的疼痛表达和体验并未受损，有时甚至过度。这一发现与包括自我报告、面部表情、发声、退缩反应和自主反应在内的多种疼痛测量结果一致。这些结果挑战了“疼痛矩阵”的概念，并提供了直接证据，表明脑岛、前扣带回和杏仁核对于感受疼痛所固有的痛苦并非必要。患者疼痛影响程度的加剧进一步表明，这些区域可能对疼痛调节更为重要，而不是为疼痛的有意识体验提供决定性的基础。
