类风湿性关节炎患者对有害热刺激的皮质反应降低。
Reduced cortical responses to noxious heat in patients with rheumatoid arthritis.
作者信息
Jones A K, Derbyshire S W
机构信息
Human Physiology and Pain Research Laboratory, University of Manchester Rheumatic Diseases Centre, Hope Hospital, Salford.
出版信息
Ann Rheum Dis. 1997 Oct;56(10):601-7. doi: 10.1136/ard.56.10.601.
OBJECTIVES
To test the hypothesis that patients with chronic inflammatory pain develop adaptive cortical responses to noxious stimulation characterised by reduced anterior cingulate responses.
METHODS
Positron emission tomography was used to measure changes in regional cerebral blood flow (rCBF) in response to an acute experimental pain stimulus in six patients with rheumatoid arthritis (RA) in comparison to six age and sex matched controls. A standardised and reproducible non-painful and painful phasic heat stimulus was delivered by a thermal probe to the back of the right hand during six two minute periods during which time rCBF measurements were made. The effects of non-painful heat were subtracted from those of painful heat to weight the analysis towards the non-discriminatory or 'suffering' components of pain processing. Significance maps of pain processing were generated and compared in each group and contrasted with results obtained in a group of patients with atypical facial pain (AFP) that have been previously published.
RESULTS
The RA patients showed remarkably damped cortical and subcortical responses to pain compared with the control group. Significant differences between the two groups were observed in the prefrontal (BA 10) and anterior cingulate (BA 24) and cingulofrontal transition cortical (BA 32) areas. The reduced anterior cingulate responses to standardised heat pain were compared with the increased cingulate responses seen in patients with psychogenically maintained pain (AFP) who had both lower pain tolerance and mood than the RA group.
CONCLUSIONS
Major cortical adaptive responses to standardised noxious heat can be measured and contrasted in patients with different types of chronic pain. The different pattern of cingulate and frontal cortical responses in the patients with inflammatory and non-nociceptive pain suggest that different mechanisms are operating, possibly at a thalamocortical level. Implications for treatment strategies for chronic pain are discussed.
目的
检验慢性炎症性疼痛患者会产生适应性皮质反应以应对有害刺激这一假说，其特征为前扣带回反应减弱。
方法
采用正电子发射断层扫描技术，测量6名类风湿性关节炎（RA）患者及6名年龄和性别匹配的对照组受试者在急性实验性疼痛刺激下的局部脑血流量（rCBF）变化。在六个两分钟时间段内，通过热探头向右手背施加标准化且可重复的非疼痛性和疼痛性相位热刺激，期间进行rCBF测量。从疼痛性热刺激的效果中减去非疼痛性热刺激的效果，以使分析更侧重于疼痛处理的非辨别性或“痛苦”成分。生成并比较每组的疼痛处理显著性图谱，并与先前发表的一组非典型面部疼痛（AFP）患者的结果进行对比。
结果
与对照组相比，RA患者对疼痛的皮质和皮质下反应明显减弱。两组在额叶前部（BA 10）、前扣带回（BA 24）和扣带额叶过渡皮质（BA 32）区域存在显著差异。将标准化热痛刺激下前扣带回反应的减弱与精神源性疼痛（AFP）患者中观察到的扣带回反应增强进行比较，后者的疼痛耐受性和情绪均低于RA组。
结论
可以测量并对比不同类型慢性疼痛患者对标准化有害热刺激的主要皮质适应性反应。炎症性疼痛和非伤害性疼痛患者扣带回和额叶皮质反应的不同模式表明，可能在丘脑皮质水平存在不同的机制在起作用。文中讨论了对慢性疼痛治疗策略的启示。
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