躯体和情感疼痛通路的损伤均会导致突显网络连接性降低。

Lesions to both somatic and affective pain pathways lead to decreased salience network connectivity.

作者信息

Jalon Itamar, Berger Assaf, Shofty Ben, Goldway Noam, Artzi Moran, Gurevitch Guy, Hochberg Uri, Tellem Rotem, Hendler Talma, Gonen Tal, Strauss Ido

机构信息

Department of Psychology, Tel Aviv University, Tel Aviv 6997801, Israel.

Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.

出版信息

Brain. 2023 May 2;146(5):2153-2162. doi: 10.1093/brain/awac403.

Abstract

Human pain is a salient stimulus composed of two main components: a sensory/somatic component, carrying peripheral nociceptive sensation via the spinothalamic tract and brainstem nuclei to the thalamus and then to sensory cortical regions, and an affective (suffering) component, where information from central thalamic nuclei is carried to the anterior insula, dorsal anterior cingulate cortex and other regions. While the sensory component processes information about stimulus location and intensity, the affective component processes information regarding pain-related expectations, motivation to reduce pain and pain unpleasantness. Unlike investigations of acute pain that are based on the introduction of real-time stimulus during brain recordings, chronic pain investigations are usually based on longitudinal and case-control studies, which are limited in their ability to infer the functional network topology of chronic pain. In the current study, we utilized the unique opportunity to target the CNS's pain pathways in two different hierarchical locations to establish causality between pain relief and specific connectivity changes seen within the salience and sensorimotor networks. We examined how lesions to the affective and somatic pain pathways affect resting-state network topology in cancer patients suffering from severe intractable pain. Two procedures have been employed: percutaneous cervical cordotomy (n = 15), hypothesized to disrupt the transmission of the sensory component of pain along the spinothalamic tract, or stereotactic cingulotomy (n = 7), which refers to bilateral intracranial ablation of an area in the dorsal anterior cingulate cortex and is known to ameliorate the affective component of pain. Both procedures led to immediate significant alleviation of experienced pain and decreased functional connectivity within the salience network. However, only the sensory procedure (cordotomy) led to decreased connectivity within the sensorimotor network. Thus, our results support the existence of two converging systems relaying experienced pain, showing that pain-related suffering can be either directly influenced by interfering with the affective pathway or indirectly influenced by interfering with the ascending spinothalamic tract.

摘要

人类疼痛是一种显著的刺激,由两个主要成分组成:一个感觉/躯体成分,通过脊髓丘脑束和脑干核将外周伤害性感觉传递至丘脑,然后再传递至感觉皮层区域;另一个情感(痛苦)成分,来自丘脑中央核的信息被传递至前脑岛、背侧前扣带回皮层和其他区域。虽然感觉成分处理有关刺激位置和强度的信息,但情感成分处理与疼痛相关的期望、减轻疼痛的动机和疼痛不适感等信息。与基于在脑记录期间引入实时刺激的急性疼痛研究不同,慢性疼痛研究通常基于纵向和病例对照研究,其推断慢性疼痛功能网络拓扑结构的能力有限。在本研究中,我们利用独特的机会,在两个不同的层次位置靶向中枢神经系统的疼痛通路,以确定疼痛缓解与在显著网络和感觉运动网络中观察到的特定连接变化之间的因果关系。我们研究了情感性和躯体性疼痛通路的损伤如何影响患有严重顽固性疼痛的癌症患者的静息态网络拓扑结构。采用了两种手术:经皮颈髓切断术(n = 15),推测该手术会破坏沿脊髓丘脑束的疼痛感觉成分的传递;或立体定向扣带回切开术(n = 7),该手术是指双侧颅内切除背侧前扣带回皮层的一个区域,已知该手术可改善疼痛的情感成分。两种手术均导致所经历的疼痛立即显著减轻,且显著网络内的功能连接性降低。然而,只有感觉手术(脊髓切断术)导致感觉运动网络内的连接性降低。因此,我们的结果支持存在两个传递所经历疼痛的汇聚系统,表明与疼痛相关的痛苦既可以通过干扰情感通路直接受到影响,也可以通过干扰脊髓丘脑束的上行传导间接受到影响。

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