From the Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.
Anesthesiology. 2018 Jun;128(6):1241-1254. doi: 10.1097/ALN.0000000000002137.
Neuroimaging research has demonstrated definitive involvement of the central nervous system in the development, maintenance, and experience of chronic pain. Structural and functional neuroimaging has helped elucidate central nervous system contributors to chronic pain in humans. Neuroimaging of pain has provided a tool for increasing our understanding of how pharmacologic and psychologic therapies improve chronic pain. To date, findings from neuroimaging pain research have benefitted clinical practice by providing clinicians with an educational framework to discuss the biopsychosocial nature of pain with patients. Future advances in neuroimaging-based therapeutics (e.g., transcranial magnetic stimulation, real-time functional magnetic resonance imaging neurofeedback) may provide additional benefits for clinical practice. In the future, with standardization and validation, brain imaging could provide objective biomarkers of chronic pain, and guide treatment for personalized pain management. Similarly, brain-based biomarkers may provide an additional predictor of perioperative prognoses.
神经影像学研究已经明确证明了中枢神经系统在慢性疼痛的发展、维持和体验中的作用。结构性和功能性神经影像学帮助阐明了中枢神经系统对人类慢性疼痛的贡献。疼痛的神经影像学为我们提供了一种工具，以增加我们对药物和心理治疗如何改善慢性疼痛的理解。迄今为止，神经影像学疼痛研究的发现通过为临床医生提供一个教育框架，与患者讨论疼痛的生物心理社会性质，从而使临床实践受益。基于神经影像学的治疗方法的未来进展（例如，经颅磁刺激、实时功能磁共振成像神经反馈）可能为临床实践提供额外的益处。将来，随着标准化和验证，脑成像可以提供慢性疼痛的客观生物标志物，并指导针对个性化疼痛管理的治疗。同样，基于大脑的生物标志物可能为围手术期预后提供额外的预测指标。
