Derbyshire S W, Jones A K, Devani P, Friston K J, Feinmann C, Harris M, Pearce S, Watson J D, Frackowiak R S
MRC Cyclotron Unit, Hammersmith Hospital, London, UK.
J Neurol Neurosurg Psychiatry. 1994 Oct;57(10):1166-72. doi: 10.1136/jnnp.57.10.1166.
The localised PET cerebral correlates of the painful experience in the normal human brain have previously been demonstrated. This study examined whether these responses are different in patients with chronic atypical facial pain. The regional cerebral responses to non-painful and painful thermal stimuli in six female patients with atypical facial pain and six matched female controls were studied by taking serial measurements of regional blood flow by PET. Both groups displayed highly significant differences in responses to painful heat compared with non-painful heat in the thalamus, anterior cingulate cortex (area 24), lentiform nucleus, insula, and prefrontal cortex. These structures are closely related to the "medial pain system". The atypical facial pain group had increased blood flow in the anterior cingulate cortex and decreased blood flow in the prefrontal cortex. These findings show the importance of the anterior cingulate cortex and the reciprocal (possibly inhibitory) connections with the prefrontal cortex in the processing of pain in patients with this disorder. A hypothesis is proposed to explain the mechanisms of cognitive and pharmacological manipulation of these pain processes.
先前已证实正常人类大脑中疼痛体验的局部正电子发射断层扫描（PET）脑关联。本研究调查了这些反应在慢性非典型面部疼痛患者中是否不同。通过PET对局部血流进行连续测量，研究了6名患有非典型面部疼痛的女性患者和6名匹配的女性对照对非疼痛和疼痛热刺激的局部脑反应。与非疼痛热刺激相比，两组在丘脑、前扣带回皮质（24区）、豆状核、岛叶和前额叶皮质对疼痛热刺激的反应均显示出高度显著差异。这些结构与“内侧疼痛系统”密切相关。非典型面部疼痛组在前扣带回皮质血流增加，前额叶皮质血流减少。这些发现表明前扣带回皮质以及与前额叶皮质的相互（可能是抑制性）连接在该疾病患者疼痛处理中的重要性。提出了一个假设来解释这些疼痛过程的认知和药理学操纵机制。
