Jones Scott A, Morales Angelica M, Holley Amy L, Wilson Anna C, Nagel Bonnie J
Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
Neuroimage Clin. 2020;27:102326. doi: 10.1016/j.nicl.2020.102326. Epub 2020 Jun 25.
Pain during adolescence is common and is associated with future pain chronicity and mental health in adulthood. However, understanding of the neural underpinnings of chronic pain has largely come from studies in adults, with recent studies in adolescents suggesting potentially unique neural features during this vulnerable developmental period. In addition to alterations in the pain network, resting state functional magnetic resonance imaging studies in adults suggest alterations in the default mode network (DMN), involved in internally-driven, self-referential thought, may underlie chronic pain; however, these findings have yet to be examined in adolescents. The current study sought to investigate associations between pain frequency and intensity, and disruptions in DMN connectivity, in adolescents. Adolescents (ages 12-20) with varying levels of pain frequency and intensity, recruited from a pediatric pain clinic and the local community (n = 86; 60% female), underwent resting state functional magnetic resonance imaging. Using independent components analysis, the DMN was identified and correlated voxel-wise to assess associations between pain frequency and intensity and DMN connectivity. Findings revealed that adolescents with greater pain frequency demonstrated greater DMN to superior frontal gyrus connectivity, while adolescents with greater pain intensity demonstrated lesser DMN to cerebellum (lobule VIII) connectivity, during rest. These findings suggest that increasing levels of pain are associated with potential desegregation of the DMN and the prefrontal cortex, important for cognitive control, and with novel patterns of DMN to cerebellum connectivity. These findings may prove beneficial as neurobiological targets for future treatment efforts in adolescents.
青少年时期的疼痛很常见，且与成年后的慢性疼痛及心理健康相关。然而，对慢性疼痛神经基础的理解大多来自对成年人的研究，近期针对青少年的研究表明，在这个脆弱的发育阶段可能存在独特的神经特征。除了疼痛网络的改变，针对成年人的静息态功能磁共振成像研究表明，参与内在驱动、自我参照思维的默认模式网络（DMN）的改变可能是慢性疼痛的基础；然而，这些发现尚未在青少年中得到验证。本研究旨在调查青少年疼痛频率和强度与DMN连接中断之间的关联。从儿科疼痛诊所和当地社区招募了疼痛频率和强度各异的青少年（12 - 20岁，n = 86；60%为女性），进行静息态功能磁共振成像检查。使用独立成分分析识别出DMN，并进行体素级相关性分析，以评估疼痛频率和强度与DMN连接之间的关联。研究结果显示，疼痛频率较高的青少年在静息状态下，DMN与额上回的连接更强，而疼痛强度较大的青少年，DMN与小脑（小叶VIII）的连接较弱。这些发现表明，疼痛程度的增加与DMN和前额叶皮质的潜在分离有关，前额叶皮质对认知控制很重要，同时也与DMN与小脑连接的新模式有关。这些发现可能对未来青少年治疗的神经生物学靶点有益。
