Departments of Neurobiology and Anatomy and.
Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
Pain. 2019 Sep;160(9):2028-2035. doi: 10.1097/j.pain.0000000000001595.
Pain and depressive mood commonly exhibit a comorbid relationship. Yet, the brain mechanisms that moderate the relationship between dysphoric mood and pain remain unknown. An exploratory analysis of functional magnetic resonance imaging, behavioral, and psychophysical data was collected from a previous study in 76 healthy, nondepressed, and pain-free individuals. Participants completed the Beck Depression Inventory-II (BDI), a measure of negative mood/depressive symptomology, and provided pain intensity and pain unpleasantness ratings in response to noxious heat (49°C) during perfusion-based, arterial spin-labeled functional magnetic resonance imaging. Moderation analyses were conducted to determine neural mechanisms involved in facilitating the hypothesized relationship between depressive mood and pain sensitivity. Higher BDI-II scores were positively associated with pain intensity (R = 0.10; P = 0.006) and pain unpleasantness (R = 0.12; P = 0.003) ratings. There was a high correlation between pain intensity and unpleasantness ratings (r = 0.94; P < 0.001); thus, brain moderation analyses were focused on pain intensity ratings. Individuals with higher levels of depressive mood exhibited heightened sensitivity to experimental pain. Greater activation in regions supporting the evaluation of pain (ventrolateral prefrontal cortex; anterior insula) and sensory-discrimination (secondary somatosensory cortex; posterior insula) moderated the relationship between higher BDI-II scores and pain intensity ratings. This study demonstrates that executive-level and sensory-discriminative brain mechanisms play a multimodal role in facilitating the bidirectional relationship between negative mood and pain.
疼痛和抑郁情绪通常表现出共病关系。然而，调节抑郁情绪与疼痛之间关系的大脑机制尚不清楚。对来自 76 名健康、无抑郁和无痛个体的先前研究中的功能磁共振成像、行为和心理物理数据进行了探索性分析。参与者完成贝克抑郁量表第二版（BDI），这是一种衡量负面情绪/抑郁症状的量表，并在基于灌注的动脉自旋标记功能磁共振成像中对有害热（49°C）做出疼痛强度和疼痛不愉快度评分。进行了调节分析，以确定在假设的抑郁情绪与疼痛敏感性之间的关系中起作用的神经机制。较高的 BDI-II 评分与疼痛强度（R = 0.10；P = 0.006）和疼痛不愉快度（R = 0.12；P = 0.003）评分呈正相关。疼痛强度和不愉快度评分之间存在高度相关性（r = 0.94；P < 0.001）；因此，大脑调节分析集中在疼痛强度评分上。抑郁情绪较高的个体对实验性疼痛表现出更高的敏感性。支持疼痛评估（腹外侧前额叶皮层；前岛叶）和感觉辨别（次级体感皮层；后岛叶）的区域的更大激活调节了更高的 BDI-II 评分与疼痛强度评分之间的关系。这项研究表明，执行水平和感觉辨别大脑机制在促进负面情绪和疼痛之间的双向关系中起着多模态作用。
