Li Xinyi, Kass Gabriel, Wiers Corinde E, Shi Zhenhao
Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA.
Curr Addict Rep. 2024;11(5):797-808. doi: 10.1007/s40429-024-00593-9. Epub 2024 Jul 29.
The brain's salience network (SN), primarily comprising the anterior insula and anterior cingulate cortex, plays a key role in detecting salient stimuli and processing physical and socioemotional pain (e.g., social rejection). Mounting evidence underscores an altered SN in the etiology and maintenance of substance use disorders (SUDs). This paper aims to synthesize recent functional neuroimaging research emphasizing the SN's involvement in SUDs and physical/socioemotional pain and explore the therapeutic prospects of targeting the SN for SUD treatment.
The SN is repeatedly activated during the experience of both physical and socioemotional pain. Altered activation within the SN is associated with both SUDs and chronic pain conditions, characterized by aberrant activity and connectivity patterns as well as structural changes. Among individuals with SUDs, functional and structural alterations in the SN have been linked to abnormal salience attribution (e.g., heightened responsiveness to drug-related cues), impaired cognitive control (e.g., impulsivity), and compromised decision-making processes. The high prevalence of physical and socioemotional pain in the SUD population may further exacerbate SN alterations, thus contributing to hindered recovery progress and treatment failure. Interventions targeting the restoration of SN functioning, such as real-time functional MRI feedback, neuromodulation, and psychotherapeutic approaches, hold promise as innovative SUD treatments.
The review highlights the significance of alterations in the structure and function of the SN as potential mechanisms underlying the co-occurrence of SUDs and physical/socioemotional pain. Future work that integrates neuroimaging with other research methodologies will provide novel insights into the mechanistic role of the SN in SUDs and inform the development of next-generation treatment modalities.
大脑的突显网络（SN）主要由前脑岛和前扣带回皮质组成，在检测突显刺激以及处理身体疼痛和社会情感疼痛（如社会排斥）方面发挥关键作用。越来越多的证据强调，在物质使用障碍（SUDs）的病因和维持过程中，突显网络发生了改变。本文旨在综合近期的功能神经影像学研究，强调突显网络在物质使用障碍以及身体/社会情感疼痛中的作用，并探讨针对突显网络进行物质使用障碍治疗的前景。
在身体疼痛和社会情感疼痛体验过程中，突显网络会反复被激活。突显网络内激活的改变与物质使用障碍和慢性疼痛状况均相关，其特征为异常的活动和连接模式以及结构变化。在患有物质使用障碍的个体中，突显网络的功能和结构改变与异常的突显归因（如对与药物相关线索的反应增强）、认知控制受损（如冲动性）以及决策过程受损有关。物质使用障碍人群中身体疼痛和社会情感疼痛的高患病率可能会进一步加剧突显网络的改变，从而导致康复进程受阻和治疗失败。针对恢复突显网络功能的干预措施，如实时光功能磁共振成像反馈、神经调节和心理治疗方法，有望成为创新的物质使用障碍治疗方法。
该综述强调了突显网络结构和功能改变作为物质使用障碍与身体/社会情感疼痛共现潜在机制的重要性。未来将神经影像学与其他研究方法相结合的工作，将为突显网络在物质使用障碍中的机制作用提供新的见解，并为下一代治疗模式的开发提供信息。
