Konno Shin-Ichi, Sekiguchi Miho
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan.
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan.
J Orthop Sci. 2018 Jan;23(1):3-7. doi: 10.1016/j.jos.2017.11.007. Epub 2017 Nov 20.
Most chronic low back pain includes elements of nociceptive pain, neuropathic pain, and nonorganic pain. We conducted screening for nonorganic pain with use of the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP), which is simple and can be used for multidimensional assessment. Research on pain areas using functional magnetic resonance imaging (fMRI) and positron emission tomography has shown that the dopamine system contributes to the pathology of chronic low back pain. Chronic low back pain patients show decreased activation of the anterior cingulate cortex, prefrontal cortex, and nucleus accumbens. Given that both the anterior cingulate cortex and prefrontal cortex belong to the descending inhibitory system, and that the nucleus accumbens, which is involved in the dopamine system, releases μ-opioids that act to relieve pain, decreased activation in these three brain regions may be related to decreased function of the descending inhibitory system. A pathological condition that can be explained at the molecular biological level clearly exists between chronic low back pain and psychosocial factors, and investigations of a pathological condition of chronic low back pain including brain function are needed.
大多数慢性下腰痛包括伤害感受性疼痛、神经性疼痛和非器质性疼痛成分。我们使用骨科患者精神问题简易量表（BS-POP）对非器质性疼痛进行筛查，该量表简单且可用于多维度评估。使用功能磁共振成像（fMRI）和正电子发射断层扫描对疼痛区域进行的研究表明，多巴胺系统与慢性下腰痛的病理过程有关。慢性下腰痛患者的前扣带回皮质、前额叶皮质和伏隔核激活减少。鉴于前扣带回皮质和前额叶皮质均属于下行抑制系统，且参与多巴胺系统的伏隔核释放可缓解疼痛的μ-阿片类物质，这三个脑区激活减少可能与下行抑制系统功能降低有关。慢性下腰痛与社会心理因素之间显然存在一种可在分子生物学水平上解释的病理状态，因此需要对包括脑功能在内的慢性下腰痛病理状态进行研究。
