Neurology Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China.
Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710071, People's Republic of China.
Brain Imaging Behav. 2021 Jun;15(3):1335-1343. doi: 10.1007/s11682-020-00332-4.
Patients with major depressive disorder (MDD) often report pain; however, the pain-related brain mechanism that contributes to MDD with pain remains largely unclear. In the current study, we aimed to observe the cortical responses by employing fMRI technique combined with thermal stimulation paradigm in 17 major depressive disorder patients with pain (MDDP), 19 major depressive disorder patients without pain (MDDNP), and 25 age- and gender-matched healthy control (HC) subjects. Participants completed the Hamilton Depression Rating Scale-17 (HAMD-17) and provided pain intensity ratings in response to noxious heat (51 °C) during task-fMRI scanning by visual analogue scale (VAS). In our results, there was no difference in pain intensity ratings during tonic heat stimulation between the HC group and MDDNP group (p > 0.05), while the MDDNP group had significantly higher HAMD scores compared with the HC group (p < 0.001). The MDDNP group had decreased brain activation in the postcentral gyrus (PCG) compared with the HC group, implying abnormal activation of the PCG may associate with the characterized depressive mood of painless MDD (p < 0.05). Additionally, there was no difference in HAMD scores between the MDDP group and MDDNP group (p > 0.05), while the MDDP group had significantly greater pain during tonic heat stimulation compared with the MDDNP group (p < 0.01). The MDDP group showed enhanced activation in the PCG compared with the MDDNP group (p < 0.05), which may relate to the abnormal regulation of pain in painful MDD. Our results suggested that higher PCG activation may play an important role in facilitating the occurrence of pain in depression.
患有重度抑郁症（MDD）的患者常报告有疼痛；然而，导致伴有疼痛的 MDD 的与疼痛相关的大脑机制在很大程度上仍不清楚。在本研究中，我们旨在通过功能磁共振成像（fMRI）技术结合热刺激范式观察皮质反应，该范式共纳入了 17 名有疼痛的重度抑郁症患者（MDDP）、19 名无疼痛的重度抑郁症患者（MDDNP）和 25 名年龄和性别匹配的健康对照（HC）受试者。参与者在任务性 fMRI 扫描过程中完成汉密尔顿抑郁量表-17 项（HAMD-17），并通过视觉模拟量表（VAS）对有害热刺激（51°C）的疼痛强度进行评分。在我们的结果中，HC 组和 MDDNP 组之间在热刺激强直期间的疼痛强度评分没有差异（p>0.05），而 MDDNP 组的 HAMD 评分明显高于 HC 组（p<0.001）。与 HC 组相比，MDDNP 组的中央后回（PCG）的脑激活明显减少，这表明 PCG 的异常激活可能与无痛性 MDD 的特征性抑郁情绪有关（p<0.05）。此外，MDDP 组和 MDDNP 组之间的 HAMD 评分没有差异（p>0.05），而 MDDP 组在热刺激强直期间的疼痛明显大于 MDDNP 组（p<0.01）。与 MDDNP 组相比，MDDP 组的 PCG 激活增强（p<0.05），这可能与疼痛性 MDD 中疼痛的异常调节有关。我们的结果表明，较高的 PCG 激活可能在促进抑郁中疼痛的发生中起重要作用。
