Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium.
Pain in Motion International Research Group, Antwerp, Belgium.
Pain. 2023 Sep 1;164(9):1954-1964. doi: 10.1097/j.pain.0000000000002890. Epub 2023 Mar 22.
Pain-related distress contributes to long-term disability in chronic whiplash-associated disorders. Recently, neuroimaging studies have revealed altered neural responses to viewing pictures of movements associated with back pain in key regions for threat and affective processing. In this study, we examined neural correlates of imagining neck-specific movements designed to elicit pain-related distress in individuals with whiplash-associated disorders (n = 63) when compared with that in sex-matched pain-free controls (n = 32). In the scanner, participants were presented with neck-specific movement-related pictures divided into 3 categories (high fear, moderate-fear, and neutral control pictures) and asked to imagine how they would feel if they were performing the movement. Whole-brain analyses revealed greater differential activation (high-fear vs neutral) in individuals with whiplash-associated disorders when compared with that in pain-free controls in 6 clusters including right and left postcentral gyri, left parietal operculum, dorsal precuneus, left superior frontal gyrus/anterior cingulate cortex, and posterior cingulate cortex/ventral precuneus. For the contrast moderate-fear vs neutral, patients showed greater differential activation than controls in the right and left posterolateral cerebellum. Activation patterns in the precuneus and posterior cingulate cortex were negatively associated with pain-related fear, but no other correlations were observed. Together, the findings suggest that when conceptualizing neck-specific movements associated with pain, people with chronic whiplash-associated disorders may predict-and potentially amplify-their sensory and affective consequences and therewith trigger dysfunctional affective and/or behavioral responses. Herewith, we provide new insights into the neural mechanisms underlying chronic pain in people with whiplash-associated disorders, pointing towards a complex interplay between cognitive/affective and sensorimotor circuitry.
疼痛相关的困扰是慢性挥鞭样损伤相关疾病导致长期残疾的原因。最近，神经影像学研究揭示了在与威胁和情感处理相关的关键区域，观看与背痛相关的运动图片时，大脑的神经反应发生了改变。在这项研究中，我们比较了慢性挥鞭样损伤相关疾病患者（n=63）和性别匹配的无痛对照组（n=32）在想象专门引起疼痛相关困扰的颈部运动时的大脑神经关联。在扫描过程中，参与者观看了专门针对颈部运动的相关图片，这些图片分为 3 类（高度恐惧、中度恐惧和中性对照图片），并被要求想象自己在执行这些运动时的感受。全脑分析显示，与无痛对照组相比，慢性挥鞭样损伤相关疾病患者在看到高度恐惧图片时，大脑的 6 个区域（右侧和左侧中央后回、左侧顶下小叶、背侧楔前叶、左侧额上回/前扣带皮质和后扣带皮质/腹侧楔前叶）的激活差异更大。对于中度恐惧与中性的对比，患者的右侧和左侧小脑后外侧回的激活差异大于对照组。楔前叶和后扣带皮质的激活模式与疼痛相关的恐惧呈负相关，但没有观察到其他相关性。总之，这些发现表明，当人们想象与疼痛相关的特定颈部运动时，慢性挥鞭样损伤相关疾病患者可能会预测并潜在放大他们的感觉和情感后果，并因此引发功能失调的情感和/或行为反应。由此，我们提供了慢性挥鞭样损伤相关疾病患者慢性疼痛的神经机制的新见解，指出认知/情感和感觉运动回路之间存在复杂的相互作用。
