Strigo Irina A, Spadoni Andrea D, Simmons Alan N
Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, San Francisco, CA, United States.
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.
Front Pain Res (Lausanne). 2022 May 10;3:871961. doi: 10.3389/fpain.2022.871961. eCollection 2022.
Trauma and posttraumatic stress are highly comorbid with chronic pain and are often antecedents to developing chronic pain conditions. Pain and trauma are associated with greater utilization of medical services, greater use of psychiatric medication, and increased total cost of treatment. Despite the high overlap in the clinic, the neural mechanisms of pain and trauma are often studied separately. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) scans were completed among a diagnostically heterogeneous sample of veterans with a range of back pain and trauma symptoms. Using Group Iterative Multiple Model Estimation (GIMME), an effective functional connectivity analysis, we explored an unsupervised model deriving subgroups based on path similarity in defined regions of interest (ROIs) from brain regions implicated in the experience of pain and trauma. Three subgroups were identified by patterns in functional connection and differed significantly on several psychological measures despite similar demographic and diagnostic characteristics. The first subgroup was highly connected overall, was characterized by functional connectivity from the nucleus accumbens (NAc), the anterior cingulate cortex (ACC), and the posterior cingulate cortex (PCC) to the insula and scored low on pain and trauma symptoms. The second subgroup did not significantly differ from the first subgroup on pain and trauma measures but was characterized by functional connectivity from the ACC and NAc to the thalamus and from ACC to PCC. The third subgroup was characterized by functional connectivity from the thalamus and PCC to NAc and scored high on pain and trauma symptoms. Our results suggest that, despite demographic and diagnostic similarities, there may be neurobiologically dissociable biotypes with different mechanisms for managing pain and trauma. These findings may have implications for the determination of appropriate biotype-specific interventions that target these neurological systems.
创伤和创伤后应激与慢性疼痛高度共病，且常常是慢性疼痛状况发展的先兆。疼痛和创伤与更多地使用医疗服务、更多地使用精神科药物以及治疗总成本增加有关。尽管在临床上两者高度重叠，但疼痛和创伤的神经机制通常是分开研究的。在本研究中，对一组具有多种背痛和创伤症状的诊断异质性退伍军人样本进行了静息态功能磁共振成像（rs-fMRI）扫描。使用组迭代多模型估计（GIMME）这一有效的功能连接分析方法，我们探索了一种无监督模型，该模型基于与疼痛和创伤体验相关的脑区中定义的感兴趣区域（ROI）的路径相似性来推导亚组。通过功能连接模式确定了三个亚组，尽管人口统计学和诊断特征相似，但在几项心理测量指标上存在显著差异。第一个亚组总体连接性高，其特征是伏隔核（NAc）、前扣带回皮质（ACC）和后扣带回皮质（PCC）与脑岛之间存在功能连接，且疼痛和创伤症状得分较低。第二个亚组在疼痛和创伤测量指标上与第一个亚组无显著差异，但其特征是ACC和NAc与丘脑之间以及ACC与PCC之间存在功能连接。第三个亚组的特征是丘脑和PCC与NAc之间存在功能连接，且疼痛和创伤症状得分较高。我们的结果表明，尽管人口统计学和诊断相似，但可能存在神经生物学上可分离的生物类型，它们具有不同的疼痛和创伤管理机制。这些发现可能对确定针对这些神经系统的适当生物类型特异性干预措施具有启示意义。
