Pan Sian, Wang Shaohua, Xue Xiao, Yuan Hanyu, Li Juan, Liu Yu, Yue Zenghui
College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China.
Department of Rehabilitation Medicine, Zhuzhou Central Hospital, Zhuzhou 412000, Hunan, China.
Evid Based Complement Alternat Med. 2022 Nov 10;2022:3759181. doi: 10.1155/2022/3759181. eCollection 2022.
Pain is an intrinsically unpleasant experience with features that protect an organism by promoting motivation and learning. Pain relief, a negative reinforcement of pain, is considered a reward and activates the brain's reward system. The reward circuit in the brain involves reward and pain. Acupuncture has a multidimensional and comprehensive regulating effect on chronic pain. However, the reward effect of acupuncture in relieving chronic pain and the mechanism of the brain reward circuit involved in acupuncture analgesia are not thoroughly studied. In this article, we have reviewed the definition of pain abnormalities and negative emotions in patients with chronic pain, the conceptual characteristics of analgesic reward, and the new progress in studying brain reward circuits and functions. Moreover, we have expounded on the critical clinical and scientific significance of studying the reward effect of acupuncture analgesia and related brain reward circuits, the pain mechanism obtained from human neuroimaging studies, and the survey results on the effects of acupuncture on reward/motivation circuits. Some viewpoints and suggestions on the reward effect of acupuncture analgesia and related reward circuits have been put forward to clarify the multidimensional characteristics and benign regulation of acupuncture analgesia. Studies on the reward effect of acupuncture in relieving chronic pain and the regulating effect of the brain reward loop on acupuncture analgesia help to deepen the clinical understanding of acupuncture analgesia, innovate the research concept of acupuncture analgesia, and provide help for further studies on the central mechanism of acupuncture in improving chronic pain in the future.
疼痛是一种本质上令人不快的体验，其特征是通过促进动机和学习来保护机体。疼痛缓解作为疼痛的一种负性强化，被视为一种奖赏并激活大脑的奖赏系统。大脑中的奖赏回路涉及奖赏和疼痛。针灸对慢性疼痛具有多维度、综合性的调节作用。然而，针灸在缓解慢性疼痛中的奖赏效应以及参与针刺镇痛的大脑奖赏回路机制尚未得到充分研究。在本文中，我们综述了慢性疼痛患者疼痛异常和负性情绪的定义、镇痛奖赏的概念特征以及大脑奖赏回路和功能研究的新进展。此外，我们阐述了研究针刺镇痛奖赏效应及相关大脑奖赏回路的关键临床和科学意义、从人类神经影像学研究中获得的疼痛机制以及针刺对奖赏/动机回路影响的调查结果。针对针刺镇痛奖赏效应及相关奖赏回路提出了一些观点和建议，以阐明针刺镇痛的多维度特征和良性调节作用。对针灸缓解慢性疼痛的奖赏效应以及大脑奖赏环路对针刺镇痛的调节作用进行研究，有助于深化临床对针刺镇痛的认识，创新针刺镇痛的研究理念，并为未来进一步研究针刺改善慢性疼痛的中枢机制提供帮助。
