Shokouhi Mahsa, Davis Karen D, Moulin Dwight E, Morley-Forster Pat, Nielson Warren R, Bureau Yves, St Lawrence Keith
*Lawson Health Research Institute, St. Joseph's Health Care London Departments of †Medical Biophysics ∥Clinical Neurosciences and Oncology ¶Anesthesia and Perioperative Medicine #Psychology, The University of Western Ontario, London ‡Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Research Institute §Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Clin J Pain. 2016 Jun;32(6):495-505. doi: 10.1097/AJP.0000000000000295.
Pain disability is a major impediment to fibromyalgia (FM) patients' quality of life. Neuroimaging studies have demonstrated abnormal pain processing in FM. However, it is not known whether there are brain abnormalities linked to pain disability. Understanding neural correlates of pain disability in FM, independent from pain intensity, could provide a framework to guide future more efficient therapy strategies to improve patients' functional ability.
We used arterial spin labeling to image cerebral blood flow (CBF) in 23 FM patients and 16 controls. Functional connectivity was also estimated using blood oxygenation level-dependent imaging to further investigate the possible underpinnings of the observed CBF changes.
Among patients, CBF in the basal ganglia correlated negatively with pain disability index and positively with the overall impact of FM (Fibromyalgia Impact Questionnaire) but did not correlate with pain intensity. Whole-brain analysis revealed no CBF differences between the 2 groups; however, post hoc analysis in the basal ganglia showed CBF reductions mainly in the right putamen and right lateral globus pallidus in patients, likely reflecting the negative correlation with the pain disability index. However, the connectivity of the corresponding corticobasal ganglia-thalamus loop, that is, motor network (the connection between supplementary motor area, putamen, and thalamus) remained intact.
Basal ganglia perfusion reflects long-term symptoms, including somatic and psychological components of FM rather than pain intensity. These CBF findings may reflect differences in behavioral and psychological responses between patients.
疼痛功能障碍是纤维肌痛（FM）患者生活质量的主要障碍。神经影像学研究已证明FM患者存在疼痛处理异常。然而，尚不清楚是否存在与疼痛功能障碍相关的脑异常。了解FM患者疼痛功能障碍的神经关联，独立于疼痛强度，可为指导未来更有效的治疗策略以改善患者功能能力提供一个框架。
我们使用动脉自旋标记对23例FM患者和16名对照者的脑血流量（CBF）进行成像。还使用血氧水平依赖性功能磁共振成像估计功能连接，以进一步研究观察到的CBF变化的可能基础。
在患者中，基底神经节的CBF与疼痛功能障碍指数呈负相关，与FM的总体影响（纤维肌痛影响问卷）呈正相关，但与疼痛强度无关。全脑分析显示两组之间CBF无差异；然而，基底神经节的事后分析显示患者右侧壳核和右侧苍白球外侧的CBF主要减少，这可能反映了与疼痛功能障碍指数的负相关。然而，相应的皮质基底神经节 - 丘脑环路，即运动网络（辅助运动区、壳核和丘脑之间的连接）的连接保持完整。
基底神经节灌注反映了包括FM的躯体和心理成分在内的长期症状，而非疼痛强度。这些CBF结果可能反映了患者之间行为和心理反应的差异。
