Pan P L, Zhong J G, Shang H F, Zhu Y L, Xiao P R, Dai Z Y, Shi H C
Department of Neurology, Affiliated Yancheng Hospital of Southeast University, China.
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Eur J Pain. 2015 Oct;19(9):1224-31. doi: 10.1002/ejp.670. Epub 2015 Feb 23.
Increasing neuroimaging studies have revealed grey matter (GM) anomalies of several brain regions by voxel-based morphometry (VBM) studies in patients with neuropathic pain. The changes have been suggested to be related to central sensitization. Our aim was to investigate concurrence across VBM studies to identify whether different subtypes of neuropathic pain share a common pathophysiological basis revealed by structural abnormalities.
A systematic search of VBM studies of patients with neuropathic pain and healthy controls published in PubMed and Embase databases from January 2000 to March 2014 was conducted. A quantitative meta-analysis of whole-brain VBM studies in patients with neuropathic pain compared with healthy controls was performed by means of effect-size signed differential mapping.
Ten studies comprising 240 patients with neuropathic pain and 263 healthy subjects were systematically included in the present study. Compared to healthy controls, the patients showed consistent decreased GM in bilateral anterior insula and thalamus, right superior frontal gyrus and left postcentral gyrus, and increased GM in right medial frontal gyrus and right posterior insula. The results remained largely unchanged in the following jackknife sensitivity analysis.
This meta-analysis shows strong evidence of brain GM anomalies within the pain matrix in patients with neuropathic pain compared with healthy subjects. Further studies are needed to determine whether the reported changes are specific to neuropathic pain or whether they may be common to other chronic pain.
越来越多的神经影像学研究通过基于体素的形态学测量（VBM）研究揭示了神经性疼痛患者多个脑区的灰质（GM）异常。这些变化被认为与中枢敏化有关。我们的目的是调查VBM研究之间的一致性，以确定神经性疼痛的不同亚型是否共享由结构异常揭示的共同病理生理基础。
对2000年1月至2014年3月在PubMed和Embase数据库中发表的神经性疼痛患者和健康对照的VBM研究进行系统检索。通过效应大小符号差异映射对神经性疼痛患者与健康对照的全脑VBM研究进行定量荟萃分析。
本研究系统纳入了10项研究，包括240例神经性疼痛患者和263例健康受试者。与健康对照相比，患者双侧前岛叶和丘脑、右侧额上回和左侧中央后回的灰质持续减少，右侧额内侧回和右侧后岛叶的灰质增加。在随后的留一法敏感性分析中，结果基本保持不变。
这项荟萃分析显示，与健康受试者相比，神经性疼痛患者疼痛矩阵内脑灰质异常的证据确凿。需要进一步研究以确定所报告的变化是否特定于神经性疼痛，或者它们是否可能是其他慢性疼痛所共有的。
