Department of Psychiatry, First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, 030001, China.
BMC Psychiatry. 2024 Nov 27;24(1):852. doi: 10.1186/s12888-024-06321-x.
Abnormal cognitive response to pain is consistently associated with deleterious outcomes among adolescents with depression. Highly relevant to both pain and cognition, dorsolateral prefrontal cortex (DLPFC) is important to understanding pain cognition. Our study aimed to characterize the circuit of DLPFC and the efficacy of transcranial magnetic stimulation (TMS) over DLPFC on pain cognition in adolescents with depression.
Using neuroimaging data, we first compared functional connectivity (FC) of DLPFC between 60 adolescents with depression and 65 controls. The patients were then divided into add-on TMS group (N = 30) and Sertraline group (N = 30). Clinical outcome was determined using Pain Vigilance and Awareness Questionnaire (PVAQ) and Pain Catastrophizing Scale (PCS). Finally, we conducted regression analysis to assess the effect that FC of DLPFC contributes to in predicting clinical outcome.
FC analysis showed that compared to controls, patients displayed hyperconnection of left DLPFC - left triangular part of inferior frontal gyrus (IFG), which was significantly correlated with higher PCS total-, magnification- and helplessness-scores. Patients also showed hyperconnection of right DLPFC - right supramarginal gyrus (SMG), which was correlated with lower PCS total- and rumination- scores. After intervention, the add-on TMS group displayed significantly decreased score on PVAQ, PCS total and rumination. FC of left DLPFC - bilateral triangular part of IFG, - right SMG, as well as right DLPFC - left putamen, could predict the improvement of pain vigilance and magnification.
Our results point to a key role of DLPFC acting as a connection linking cognitive control and pain processing in adolescents with depression.
The study is registered in https://www.chictr.org.cn/ with a registration number ChiCTR2000039503 (date: 10.30.2020).
异常的疼痛认知反应与抑郁青少年的不良结局始终相关。背外侧前额叶皮层（DLPFC）与疼痛和认知高度相关，对理解疼痛认知很重要。我们的研究旨在描述 DLPFC 的回路以及 TMS 对 DLPFC 对抑郁青少年疼痛认知的疗效。
使用神经影像学数据，我们首先比较了 60 名抑郁青少年和 65 名对照者的 DLPFC 功能连接。然后，患者被分为 TMS 附加组（N=30）和舍曲林组（N=30）。采用疼痛警觉和意识问卷（PVAQ）和疼痛灾难化量表（PCS）来确定临床疗效。最后，我们进行了回归分析，以评估 DLPFC 的 FC 对预测临床结果的影响。
FC 分析表明，与对照组相比，患者的左侧 DLPFC-左侧额下回三角部（IFG）的连接性增加，这与较高的 PCS 总分、放大和无助得分显著相关。患者的右侧 DLPFC-右侧缘上回（SMG）的连接性也增加，这与较低的 PCS 总分和反刍得分相关。干预后，TMS 附加组的 PVAQ、PCS 总分和反刍得分显著降低。左侧 DLPFC-双侧 IFG 三角部、右侧 DLPFC-右侧 SMG 以及右侧 DLPFC-左侧壳核的 FC 可预测疼痛警觉性和放大的改善。
我们的研究结果表明，DLPFC 作为连接认知控制和疼痛处理的桥梁，在抑郁青少年中起着关键作用。
本研究在 https://www.chictr.org.cn/ 注册，注册号 ChiCTR2000039503（日期：2020 年 10 月 30 日）。
