Molina Juliana, Amaro Edson, da Rocha Liana Guerra Sanches, Jorge Liliana, Santos Flavia Heloisa, Len Claudio A
Researcher of Rheumatology Sector of Department of the Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Brain Institute and Department of Diagnostic Imaging Hospital Israelita Albert Einstein, São Paulo, Brazil.
Pediatr Rheumatol Online J. 2017 Nov 14;15(1):81. doi: 10.1186/s12969-017-0209-6.
Studies on functional magnetic resonance imaging (fMRI) have shown that adults with musculoskeletal pain syndromes tolerate smaller amount of pressure (pain) as well as differences in brain activation patterns in areas related to pain.The objective of this study was to evaluate, through fMRI, the brain activation in adolescents with idiopathic musculoskeletal pain (IMP) while performing an experimental paradigm of pain.
The study included 10 consecutive adolescents with idiopathic musculoskeletal pain (average age 16.3±1.0) and 10 healthy adolescents age-matched. fMRI exams were performed in a 3 T scanner (Magnetom Trio, Siemens) using an event-related design paradigm. Pressure stimuli were performed in the nondominant hand thumb, divided into two stages, fixed pain and variable pain. The two local Research Ethics Committees (Ethics Committee from Universidade Federal de São Paulo- Brazil, process number 0688/11, on July 1st, 2011 and Ethics Committee from Hospital Israelita Albert Einsten - Brazil, process number 1673, on October 19th, 2011) approved the study.
The idiopathic musculoskeletal pain (IMP) group showed a reduced threshold for pain (3.7 kg/cm versus 4.45 kg/cm, p = 0.005). Control group presented increased bain activation when compared to IMP group in the following areas: thalamus (p = 0.00001), precentral gyrus (p = 0.0004) and middle frontal gyrus (p = 0.03). In intragroup analysis, IMP group showed greater brain activation during the unpredictable stimuli of the variable pain stage, especially in the lingual gyrus (p = 0.0001), frontal lobe (p = 0.0001), temporal gyrus (p = 0.0001) and precentral gyrus (p = 0.03), when compared to predictable stimulus of fixed pain. The same intragroup analysis with the control group showed greater activation during the unpredictable stimuli in regions of the precentral gyrus (p = 0.0001), subcallosal area (p = 0.0001), right and left occipital fusiform gyrus (p = 0.0001; (p = 0.0007), middle gyrus (p = 0.01) and precuneus p = (0.02).
Adolescents with idiopathic musculoskeletal pain (IMP) tend to request higher brain function in cognitive-emotional areas when interpreting unpredictable sensory-perceptual situations. Therefore, it is assumed that this difference in pain processing in adolescents with IMP make the subjective experience of pain something more intense and unpleasant.
功能磁共振成像（fMRI）研究表明，患有肌肉骨骼疼痛综合征的成年人对较小压力（疼痛）的耐受性以及与疼痛相关区域的大脑激活模式存在差异。本研究的目的是通过fMRI评估患有特发性肌肉骨骼疼痛（IMP）的青少年在进行疼痛实验范式时的大脑激活情况。
该研究纳入了10名连续的患有特发性肌肉骨骼疼痛的青少年（平均年龄16.3±1.0岁）和10名年龄匹配的健康青少年。使用事件相关设计范式在3T扫描仪（西门子Magnetom Trio）中进行fMRI检查。在非优势手拇指上施加压力刺激，分为两个阶段，固定疼痛和可变疼痛。两个当地研究伦理委员会（巴西圣保罗联邦大学伦理委员会，流程编号0688/11，2011年7月1日；以及巴西以色列爱因斯坦医院伦理委员会，流程编号1673，2011年10月19日）批准了该研究。
特发性肌肉骨骼疼痛（IMP）组的疼痛阈值降低（3.7kg/cm对4.45kg/cm，p = 0.005）。与IMP组相比，对照组在以下区域的大脑激活增加：丘脑（p = 0.00001）、中央前回（p = 0.0004）和额中回（p = 0.03）。在组内分析中，与固定疼痛的可预测刺激相比，IMP组在可变疼痛阶段的不可预测刺激期间显示出更大的大脑激活，特别是在舌回（p = 0.0001）、额叶（p = 0.0001）、颞回（p = 0.0001）和中央前回（p = 0.03）。对照组的相同组内分析显示，在中央前回（p = 0.0001）、胼胝体下区（p = 0.0001）、左右枕叶梭状回（p = 0.0001；（p = 0.0007）、中回（p = 0.01）和楔前叶（p = 0.02）区域的不可预测刺激期间激活增加。
患有特发性肌肉骨骼疼痛（IMP）的青少年在解释不可预测的感觉 - 知觉情况时，倾向于在认知 - 情感区域调用更高的大脑功能。因此，据推测，IMP青少年在疼痛处理上的这种差异使得疼痛的主观体验更加强烈和不愉快。
