Mountz J M, Bradley L A, Alarcón G S
Department of Radiology, The University of Alabama at Birmingham, 35233, USA.
Am J Med Sci. 1998 Jun;315(6):385-96. doi: 10.1097/00000441-199806000-00007.
The evaluation of pain is one of the major problems facing general practitioners and specialists in medicine. Although the source of pain can be usually be traced to specific abnormalities in a given organ system, some patients present with generalized pain syndromes, such as fibromyalgia, for which no specific source can be found. Some researchers have begun to consider that although there may be a somatic source of such pain at its initiation, over time the pain may be maintained or exacerbated by functional alterations in critical regions of the brain and spinal cord that are involved in pain processing or pain inhibition. This article describes the techniques currently used to measure regional cerebral blood flow (rCBF) in the brain by single photon emission computed tomography (SPECT) imaging, and reviews the SPECT and positron emission tomography literature concerning alterations in functional brain activity associated with pain in healthy individuals and in patients with chronic pain, including those with fibromyalgia. The article concludes by describing the implications of current knowledge about pain and abnormal functional brain activity in the understanding of the pathophysiology of fibromyalgia and in the development of therapeutic strategies to manage patients with this disorder.
疼痛评估是全科医生和医学专家面临的主要问题之一。尽管疼痛的来源通常可以追溯到特定器官系统的特定异常，但一些患者表现出全身性疼痛综合征，如纤维肌痛，找不到其具体来源。一些研究人员开始认为，尽管此类疼痛在起始时可能有躯体来源，但随着时间推移，疼痛可能会因参与疼痛处理或疼痛抑制的大脑和脊髓关键区域的功能改变而持续或加剧。本文描述了目前通过单光子发射计算机断层扫描（SPECT）成像测量大脑局部脑血流量（rCBF）的技术，并回顾了关于健康个体和慢性疼痛患者（包括纤维肌痛患者）与疼痛相关的大脑功能活动改变的SPECT和正电子发射断层扫描文献。本文最后描述了当前关于疼痛和大脑异常功能活动的知识在理解纤维肌痛病理生理学以及制定治疗该疾病患者的治疗策略方面的意义。
