Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Germany.
Pain Imaging Neuroscience Group, Nuffield Department of Clinical Neurosciences & FMRIB Centre, John Radcliffe Hospital, University of Oxford, UK.
Eur J Pain. 2018 Apr;22(4):745-755. doi: 10.1002/ejp.1159. Epub 2017 Dec 14.
Recent evidence has shown that chronic back pain (CBP) can lead to functional alterations in the circuitry underlying the cognitive control of pain. Thought suppression (TS) is a common type of cognitive control of pain. Previous research has shown that TS has paradoxical effects that may increase the awareness of pain. Pain-related TS may also increase individuals' attention to pain, which may also increase pain sensation, but thus far, the relationship between pain-related TS and structural brain alterations is unknown.
In this study, we investigated a group of 30 patients 6 months after lumbar disc surgery by applying voxel-based morphometry (VBM) to identify brain regions correlated with TS scores.
Since pain-related TS has been positively correlated with depression, all calculations were controlled for depression and age. VBM revealed a negative correlation between the TS score and regional grey matter volume (GMV) in the left superior temporal gyrus (LSTG) and the left middle temporal gyrus (L MTG), which is part of the left temporoparietal junction (L TPJ). In addition, a mediation analysis revealed a significant mediation effect of the pain-related TS on the association between GMV of the left TPJ and reported pain intensity in the last 7 days.
These findings are consistent with previous research on the dysfunctional cognitive control of pain and may therefore provide potential insights into the neural substrates of obstructive cognitive control in chronic low back pain, with a special emphasis on pain-related TS.
The link between pain-related thought suppression and brain morphology may provide a new perspective on the understanding of cognitive control of pain in chronic low back pain, which may help improve cognitive behavioural therapy.
最近的证据表明，慢性背痛（CBP）会导致疼痛认知控制的基础回路出现功能改变。思维抑制（TS）是一种常见的疼痛认知控制类型。先前的研究表明，TS 具有矛盾的效果，可能会增加对疼痛的感知。与疼痛相关的 TS 也可能会增加个体对疼痛的注意力，这也可能会增加疼痛感觉，但到目前为止，与疼痛相关的 TS 和结构脑改变之间的关系尚不清楚。
在这项研究中，我们通过体素基形态测量法（VBM）对腰椎间盘手术后 6 个月的 30 名患者进行了研究，以确定与 TS 评分相关的大脑区域。
由于与疼痛相关的 TS 与抑郁呈正相关，因此所有计算都考虑了抑郁和年龄。VBM 显示，TS 评分与左侧颞上回（LSTG）和左侧颞中回（L MTG）的区域灰质体积（GMV）之间存在负相关，这些区域是左侧颞顶联合区（L TPJ）的一部分。此外，中介分析显示，与左侧 TPJ 的 GMV 相关的疼痛相关 TS 对报告的过去 7 天内疼痛强度的关联具有显著的中介作用。
这些发现与先前关于疼痛认知控制障碍的研究一致，因此可能为慢性下腰痛中阻塞性认知控制的神经基础提供潜在的见解，特别关注与疼痛相关的 TS。
与疼痛相关的思维抑制和大脑形态之间的联系可能为理解慢性下腰痛中的疼痛认知控制提供新的视角，这可能有助于改善认知行为疗法。
